The global burden of decubitus ulcers from 1990 to 2019

There are no studies assessing the epidemiology and burden of decubitus ulcers at global, regional, and national levels. We aim to report this issue from 1990 to 2019 by extracting data from the Global Burden of Disease Study (GBD) 2019 and stratifying it by age, gender, and socio-demographic index (SDI). Globally, the number of prevalent cases of decubitus ulcers in 2019 is 0.85 (95% UI 0.78 to 0.94) million. The age-standardized rates of prevalence, incidence, and years lived with disability (YLDs) in 2019 are 11.3 (95% UI 10.2 to 12.5), 41.8 (37.8 to 46.2), and 1.7 (1.2 to 2.2) per 100,000 population, and compared with 1990, it has decreased by 10.6% (95% UI 8.7% to 12.3%), 10.2% (8.2 to 11.9%), and 10.4% (8.1 to 12.5%), respectively. In addition, the global prevalence rate of decubitus ulcers increases with age, peaking at the > 95 age group among men and women. At the regional and national levels, we observe a positive correlation between age-standardized YLDs and SDI. Malaysia, Saudi Arabia, and Thailand experienced the most significant increases in age-standardized prevalence rates at the national level. Finally, we concluded that the age-standardized prevalence, incidence, and YLDs rates of decubitus ulcer declined from 1990 to 2019, with significant regional differences. In order to monitor the dynamic changes of decubitus ulcers burden, it is recommended to improve the quality of decubitus ulcer health data in all regions and countries.

Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis

Objective To evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis. Methods We conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed. Results Twenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap. Conclusions Application of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.

Design and Development of an E-Textile Mat for Assuring the Comfort of Bedridden Persons

An e-textile mat with capacitive textile sensors was designed and manufactured to monitor body position and prevent decubitus ulcers in the case of bedridden people. The sensors were incorporated through a process of machine embroidery with electrically conductive threads. A new production method for the conductive threads is still expected to be developed, resulting in good conductive properties, high wear resistance and durability. Samples of five variants of motifs without cross-stitching were studied, and the capacity and electrical resistance were determined experimentally. A prototype of the e-textile mat was made with a motif showing the best ratio between the inserted thread and the measured capacity. A hardware solution and a software application for collecting, processing and visualising the received information were developed. Tests were performed in real conditions, which clearly showed that the designed e-textile mat could be successfully applied for non-invasive and continuous control of the position of the human body in a supine position to prevent decubitus ulcers.

ASSESSMENT OF THE RISK OF DECUBITUS ULCERS USING BRADEN SCALE

Purpose: Within the behavioral guidelines of hospitalized patients who need compensatory nursing care, an assessment of the risk of decubitus ulcers is recommended to be done at regular intervals, in schedule, and after each altered state. The goal of this research is to apply the BRADEN SCALE for assessment of the risk of decubitus ulcers occurring during a hygienic toilet in sick people who need compensatory nursing care. Material/Methods: An assessment of the risk of decubitus ulcers via using the Braden scale is applied in 120 hospitalized patients during a hygienic toilet. Treatment of decubitus ulcers I and II degree is being performed when the state of the skin and wounds that have already occurred are being established. For processing, analysis and graphic presentation of the results and data, the statistic program SPSS 20.0 is being used. Results: It's reported that 50, 83% of the respondents have got quite a risk of decubitus wounds occurring, 26,67% are at great risk, and 14,17% are at moderate risk. Only 8, 33% of all patients tested are at light risk. Conclusions: In all patients tested, a various degree of decubitus wounds occurrence, is reported. This defines the importance of the nurses' hygienic care and activities for the prevention of decubitus ulcers to occur. If the prevention measures of patients who have gotten in a risk group are not observed, every decubitus wound leads to a continuous stay in the hospital and also additional treatment and tests, which automatically prolong and raise the cost of hospital treatment.

PENGARUH PERUBAHAN POSISI DALAM MENCEGAH DEKUBITUS PADA PASIEN YANG MENJALANI PERAWATAN DI RUMAH SAKIT AMINAH CILEDUG TANGERANG

Change of position is a position setting given to reduce friction on the skin so that it will reduce the chance of decubitus ulcers. This study aims to determine the effect of position changes in preventing pressure sores in patients undergoing treatment at Aminah Hospital Ciledug Tangerang. The population in this study were patients who were treated at Aminah Hospital Ciledug Tangerang and the sample studied was 44 people who were taken by using purposive sampling technique. The research method used is quasi-experimental, with a pre-test post-test with control group non randomization and data analysis using the Mann Whitney test. From the results of statistical tests using Mann Whitney, p value = 0.001, this indicates that there is an effect of changing position in preventing decubitus. The results of this study are expected to be input and can be applied by health workers (nurses) in providing nursing care to patients who experience prolonged bed rest, and it is recommended at least every 2 hours. Abstrak Perubahan posisi merupakan pengaturan posisi yang diberikan untuk mengurangi gaya gesek pada kulit sehingga akan menurunkan peluang terjadinya luka dekubitus. Penelitian ini bertujuan untuk mengetahui pengaruh perubahan posisi dalam mencegah dekubitus pada pasien yang menjalani perawatan di Rumah Sakit Aminah Ciledug Tangerang. Populasi didalam penelitian ini adalah pasien yang di rawat di Rumah Sakit Aminah Ciledug Tangerang dan sempel yang diteliti sebanyak 44 orang yang diambil dengan cara menggunakan teknik Purposive sampling. Metode penelitian yang digunakan adalah Quasi experiment, dengan desain pre-test post-test with control group non randomization dan analisa data menggunakan uji Mann Whitney. Dari hasil uji statistik dengan menggunakan Mann Whitney di dapatkan p value = 0.001, hal ini menunjukkan bahwa terdapat pengaruh dari perubahan posisi dalam mencegah decubitus. Hasil penelitian ini diharapkan menjadi masukan dan dapat diterapkan oleh petugas kesehatan (perawat) didalam pemberian asuhan keperawatan kepada pasien yang mengalami perawatan tirah baring yang lama, dan direkomendasikan minimal setiap 2 jam sekali.

Breast Cancer Treatment in a Patient with Decubitus Ulcer Infection Secondary to Spina Bifida: Surgical Resection versus Neoadjuvant Chemotherapy

Spina bifida (SB) is a congenital neural tube defect that often presents with neurological disability and decubitus ulcers. A 66-year-old woman with SB presented to our hospital with decubitus ulcers and was treated by a plastic surgeon. She was referred to our department because of a mass measuring 5 × 4 cm in the superolateral quadrant of the right breast. The size of the right axillary lymph node (LN) was 2 × 1 cm. A core-needle biopsy revealed an invasive ductal carcinoma. Total mastectomy and axillary LN dissection were planned. However, 2 days prior to surgery, the size of the mass and the LN rapidly increased to 7 × 4 cm and 3 × 2 cm, respectively. Furthermore, the enlarged LN was close to the thoracodorsal artery. Since complete resection was difficult, neoadjuvant chemotherapy was also administered. On day 11 of neoadjuvant chemotherapy, the patient was febrile and developed a decubitus ulcer infection at the buttock. The neutrophil count was within normal limits; thus, she was not diagnosed with febrile neutropenia. Follow-up computed tomography revealed a shrinking of the mass to 5 × 4 cm after the first cycle of neoadjuvant chemotherapy. After 17 days of antibiotic therapy and drainage, total mastectomy and axillary LN dissection were performed. Due to the risk of recurrence of infection, adjuvant chemotherapy was discontinued and hormone therapy was initiated. In conclusion, indications for chemotherapy should be carefully evaluated in SB patients with lower limb paralysis and decubitus ulcers.

POSSIBILITIES FOR MODIFICATION OF SURGICAL OBTURATOR INTO TEMPORARY OBTURATOR

Background: Maxillary resection causes different types of damages in the maxillofacial area, which are treated by surgical and prosthetic restorative methods. Aim: The described clinical case follows up the initial stages of the prosthetic treatment, as well as the possible modification of surgical obturator into temporary obturator in a patient with maxillary resection. Materials and methods: The prosthetic treatment of a 55-years-old female patient with a surgical operation of upper jaw cancer is described. The surgical obturator is developed a week after the resection. The preliminary impressions are taken with irreversible hydrocolloid impression material. The occlusion height and central relation are fixed by occlusion rims. The surgical obturator was fabricated by heat cured acrylic resin with a low amount of residual monomer. Moreover, metal clasps were used for retention and stability. The borders of the obturating part were covered with a thin layer of relining silicone material after the adjustment. The surgical obturator was modified into a temporary one directly in the patient's mouth after two months by applying the same rebasing material and designing a silicone hollow-bulb obturating part. Results: The treatment results revealed a successful restoration of the patient's speaking, feeding, and swallowing abilities. The application of silicone material inhibited the appearance of decubitus ulcers and facilitated the normal healing process. The direct design of hollow-bulb silicone obturating part significantly improved the retention and stability of the obturator. Conclusion: The application of prosthetic treatment methods in the first days after the maxillary resection allows for restoration of speaking and feeding.

A rare case of primary vaginal carcinoma in prolapsed uterus

Primary carcinoma is rare in gynaecological neoplasia. Vaginal carcinoma in prolapse uterus is extremely rare. We hereby present a case of 55-year-old P3L3 postmenopausal woman with complete uterine prolapse with fungating growth of 6x8 cm with two decubitus ulcers of 1x1 cm. Marginal biopsy showed well-differentiated squamous cell carcinoma of vagina. Investigation was done showed no metastasis. Patient was diagnosed with stage 2 disease. Patient underwent 5 cycles of chemotherapy with 2 cycles of radiotherapy and is being followed up. The importance of biopsy of ulcer in cases of UV prolapse in order to exclude malignancy to avoid incomplete treatment has been illustrated through this case. The need of careful evaluation of vaginal erosions in pelvic organ prolapse has been highlighted. As there is lack of well-defined treatment protocols for vaginal cancer with concurrent prolapse, the case also underlines the importance of a multidisciplinary approach involving gynaecological oncology, urogynaecology, medical oncology, surgical oncology and radiation oncology.

The Hemicorporectomy in 2020: A Case Report and Recent Advances

Chronic decubitus ulcers are a common problem in spinal cord injury (SCI) patients. Late-stage ulcers often lead to chronic osteomyelitis, which carries high rates of morbidity and mortality, as well as significant healthcare costs. Refractory decubitus ulcers are most commonly seen in the pelvis and pose a clinical challenge to provider teams caring for SCI patients. With long-term disease, surgical and antibiotic therapies may fail, which places patients at risk for entering a terminal disease state. A radical treatment for this condition was described in the early 20th century and involves amputation of the lower half of the body. This procedure, the hemicorporectomy, continues to be performed today in a very small, select group of patients. Here, a case report is described of a 39-year-old female T12 paraplegic with refractory decubitus ulcers and terminal pelvic osteomyelitis that underwent hemicorporectomy as definitive treatment. The procedure was successful and the patient was safely discharged to a long-term rehabilitation facility.

Katupila (Securinega leucopyrus) A Boon for Bedsore- A Case Report

Pressure ulcer is a sequel of tissue necrosis and ulceration due to prolonged pressure. External pressure of more than 30 mmHg on the skin leads to ischemia (reduced blood flow) causing ischeohypoxia, necrosis and ulceration. It is more common between bony prominence and an external surface. It may be due to impaired blood supply, defective nutrition and neurological deficit. Ayurveda describes this type of non-healing ulcer in terms of <em>Dusta vrana</em>, in that context <em>Acharya Sushruta</em> had also mentioned it as “<em>Dirghakalanubandhi</em>” which suggests that these kind of ulcers take longer time to heal due to underlying reasons. This article is about the single case report of a 51-year-old male patient with a stage 3 decubitus ulcer over the right heel since 2 months. As decubitus ulcers especially of stage 3 is difficult to cure, ayurvedic management with internal medication and external therapy was performed in this reported case. For Internal medication, Tablet septilin (A Patent medicine of Himalaya pharmacy, India) and <em>Punarnavadi kashay</em> (A Patent medicine of Vaidhyaratnam pharmacy, India) was used for enhancement of better wound healing. For external application Paste Katupila and honey was applied for 30 days. According to the assessment, wound showed good response within 10 days and was completely healed in 30 days.