Rapid Responses to:

EDITORIALS: Luke Vale and David W Noble Overlays or mattresses to prevent pressure sores? BMJ 2006; 332: 1401-1402 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Surgical assessment is essential in patients with pressure sores

Y.C. Chan   (24 June 2006)

Surgical assessment is essential in patients with pressure sores 24 June 2006
Y.C. Chan, Senior Vascular Fellow Department of Vascular & Endovascular Surgery, Guy's & St. Thomas' NHS Trust, London SE1 7EH, UK. Send response to journal: Re: Surgical assessment is essential in patients with pressure sores	I congratulate the BMJ in highlighting this very important problem. The formation of pressure sores, either in the sacrum or the leg, is often multi-factorial (1); and management plan goes far beyond good nursing care and provision of alternating pressure mattresses. As such, it needs to be managed in a multi-disciplinary team. Physicians may be unaware of the importance of surgery in the management of pressure sores. Referral to surgeons of different specialties is often delayed. General surgeons can debride devitalised tissues, and in selective cases, provide a temporary defunctioning colostomy in incontinent patients with extensive sacral sores. Vascular surgeons can improve the blood supply in order to encourage healing, and plastic surgical advice should be sought on the use of vacuum-assisted closure (VAC) device and various grafts or flaps (2, 3). In the case of foot or heal decubitus ulcers, clinical examination of peripheral arterial system and measurement of the ankle-brachial pressure index (ABPI) is of paramount importance. We in the vascular unit work closely with other hospital physicians (e.g. care of elderly or stroke team) looking after patients with decubitus ulcers. Patients with a decreased ABPI should have an initial arterial duplex assessment, and to proceed to angioplasty or arterial reconstructive surgery if appropriate. Osteomyelitis of the underlying bone must be ruled out, as orthopaedic debridement may be necessary. Full thickness or extensive sacral pressure sores will fail to heal if the patency of the internal iliac arteries is compromised, and such lesions are often amenable to angioplasty or stenting. Once the blood supply is restored or improved, repeated surgical debridement (often in the operating theatre) will be necessary before the placement of the VAC device. Once the ulcer bed is healthy, it will support the muscle or musculocutaneous flaps by the plastic surgeons. REFERENCES 1. Vale L, Noble DW. Overlays or mattresses to prevent pressure sores? BMJ 2006; 332(7555): 1401-1402. 2. Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs. 2005; 13(22): 1359-1365. 3. Pers M, Snorrason K, Nielsen IM. Primary results following surgical treatment of pressure sores. Scand J Plast Reconstr Surg. 1986; 20(1): 123-124. Competing interests: None declared