Wound Management of Multi-Site Pressure Ulcer at Different Stages in Elderly Patients

Shunqing Su,1 Xiumei Ding,1 Huijuan Zou,1 Yuechun Lin,1 Jianmin Huang,1 Disheng Xiong,1 Jinan Kuan,1 Yanhong Zhang,2 Rurong Xie2 1Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People’s Republic of China; 2Department of Wound Repair, Hongmei Hospital of Dongguan, Dongguang, Guangdong, 523160, People’s Republic of ChinaCorrespondence: Xiumei DingDepartment of Burn&Plast, Dalang Hospital of Dongguan, No. 85 of Jinlangzhong Street, Dalang District, Dongguang, 523780, People’s Republic of ChinaTel +86 769-83009512Fax +86 769-83033122Email ding_xm123@outlook.comObjective: The present study aims to explore the individualized treatment options for multisite pressure ulcer (PU) at various stages in elderly patients with multiple medical conditions.Methods: Stages 1 and 2 PU at 146 sites were treated with closed negative pressure suction combined with continuous micro-oxygen perfusion and the local application of foam dressings, silver ion dressings, and moist burn cream. Stages 3 and 4 PU in the sacrococcygeal region were treated with skin or myocutaneous flap transplantation.Results: Stages 1 and 2 PU healed after treatment with closed negative pressure suction combined with continuous micro-oxygen perfusion and dressing changes. One case died during hospitalization due to an illness. Skin or myocutaneous flap repair was conducted in 34 cases of stage 3 or 4 PU in the sacrococcygeal area. Of these cases, 28 achieved primary healing, and 6 required two or three surgeries, 5 of which received micro-skin implantation. In addition, 10 small deep PU at other sites were repaired by direct excision and suturing or local flap repair. Seven cases were transferred to other departments or hospitals due to concomitant diseases or were discharged automatically without surgical treatment.Conclusion: Home care for geriatric patients is difficult. PU often occur at multiple sites because of the duration of various pressures, and different sites may demonstrate different stages because of varying degrees of pressure. When actively treating stages 3 and 4 PU, the trauma management of stages 1 and 2 PU should not be neglected.Keywords: oldest-old patients, pressure ulcer, wound management, flap transplantation, micro-skin implantation