FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
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Thursday September 1st<br />
Proceedings of the 14th Annual European Pressure Ulcer Meeting<br />
Oporto, Portugal<br />
Pressure Ulcers in a Post Disaster Setting: Benefits of Advanced Wound Care Techniques<br />
McNutt, J, Miller, J, Cherry, J, Eyssallenne, A<br />
Hospital Bernard Mevs Project Medishare, Haiti, jbm911@hotmail.com<br />
Introduction<br />
On January 12, 2010 Haiti was rocked by a 7.0<br />
magnitude earthquake just outside the capital city of<br />
Port au Prince. Though the earthquake only lasted 35<br />
seconds, approx 316,000 people died, 300,000 were<br />
injured and 1,000,000 made homeless. This was<br />
devastating to a country already mired in poverty, and<br />
lack of advanced medical care. Many injuries required<br />
patients to be non-mobile before definitive care could<br />
be provided, while others were left with spinal cord<br />
injuries [SCI], conditions that occurred secondary to<br />
trauma even before the earthquake. Many of these<br />
people were left lying on the dirt floors of their tents or<br />
lying on hard cots in field hospitals with no pressure<br />
relief capabilities. Multiple pressure ulcers of all<br />
stages were created. Our presentation will discuss the<br />
need for advanced wound care techniques, especially<br />
following a disaster of this sort, types of techniques<br />
used and examples of patients treated.<br />
Methods<br />
Here we present 2 case studies of patients (E and C)<br />
treated at Hospital Bernard Mevs Project Medishare in<br />
Port au Prince, Haiti. Both had spinal cord injuries and<br />
sustained their wounds following periods of prolonged<br />
immobility and inadequate care which included lack of<br />
medical support, lack of pressure relieving surfaces<br />
and poor nutritional intake.<br />
At the time of admission to our service E (a 24 y/o<br />
quadriplegic since March 2010) had a Grade 4 sacral<br />
ulcer with comorbidities of systemic infection, severe<br />
malnutrition and severe depression. She sustained her<br />
wounds from sleeping on hard flooring.<br />
C is a 40 year old paraplegic (since 2004) who<br />
presented with multiple wounds (up to grade IV) on his<br />
sacrum and lower limbs. He lost his home in the<br />
earthquake and had moved to a tent where he slept on<br />
the ground and had no pressure relieving surfaces. He<br />
had comorbidities of severe anemia (Hg 4.4g/dL),<br />
systemic infection and severe malnutrition on<br />
admission to our hospital.<br />
Both patients were treated with a combination of<br />
surgery, silver dressings, KCI V.A.C. ® negative<br />
pressure therapy, physical therapy, appropriate<br />
pressure relief and nutritional supplementation during<br />
their stay.<br />
Results<br />
Wound measurements<br />
Patient Date Wound Size<br />
E sacrum Oct 2010 13.5 x 6.6 x 3.5cm with<br />
undermining<br />
Apr 2011 Healed<br />
C sacrum Oct 2010<br />
13.4 x10.3 x11.0cm<br />
Apr 2011<br />
Healed with STSG<br />
61<br />
C (R Troch)<br />
C (L Troch)<br />
Oct 2010<br />
Apr 2011<br />
Oct 2010<br />
April 2011<br />
6.5 x 6.2 x 1.4cm<br />
2x2cm<br />
5.7 x 5.1 x >0.1cm<br />
Healed<br />
Discussion<br />
Pressure ulcer prevention in SCI patients is a<br />
challenge. Poor nutrition and inadequate pressure<br />
relief surfaces, compounded with decreased personnel<br />
to provide care to patients in need contribute to<br />
formation of wounds. Our case studies illustrate the<br />
need for advanced wound care in a post disaster<br />
setting and show that provision of such services can<br />
offer the opportunity for complete healing of severe<br />
wounds. Due to the lack of pressure relief surfaces, it<br />
is also extremely important to increase education level<br />
in mobility and therapy techniques to prevent further<br />
pressure ulcers.<br />
It is well known that good nutrition is necessary for<br />
wound healing. Patients in “first world countries” with<br />
wounds frequently require special nutritional<br />
interventions. This is even more important in “third<br />
world” countries when even prior to a national disaster<br />
there is widespread starvation and malnutrition.<br />
Deficiencies in protein and essential vitamins weaken<br />
collagen synthesis, cellular cohesion, and leave soft<br />
tissue more susceptible to breakdown and infection<br />
due to immunosupression. [1]<br />
Use of KCI’s V.A.C. ® Negative pressure wound<br />
system, silver dressings, pressure relieving<br />
techniques, physical therapy and improved nutritional<br />
support have either closed, or greatly improved the<br />
status of the wounds of the presented patients.<br />
Educating local staff and patients in turning schedules,<br />
mobility, and proper nutrition will continue to help heal<br />
current ulcers, and hopefully prevent new pressure<br />
ulcers from forming.<br />
Clinical relevance<br />
We demonstrate herein that advanced wound care<br />
techniques, proper nutrition, education and superior<br />
support surfaces will improve success in wound<br />
healing in resource poor settings.<br />
Acknowledgements<br />
We appreciate the help of the staff and administration<br />
of Hospital Bernard Mevs, and Project Medishare, and<br />
numerous volunteers from all over the world.<br />
References<br />
[1] Bryant R., Acute and Chronic Wounds. (Mosby-<br />
Year Book Inc. 1992) p.115<br />
Copyright © 2011 by EPUAP