Pressure ulcers presentations and management at Kenyatta National Hospital and Spinal Injury Hospital

Abstract

Objective: To determine the presentation and management of patients with pressure ulcers. Design: A prospective study. Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital (NSIH). Subjects: One hundred and thirteen patients were evaluated. Ninety six patients from KNH and seventeen from NSIH. Patients admitted at Kenyatta National Hospital and National Spinal Injury Hospital with pressure ulcers during the study period. Results: Of the 113 patients, 77 (68.1%) were male and 36 (31.9%) were female. Mean age of the patients studied was 38.1 years while the range was between 12 and 74 years. Paraplegia was the main associated medical condition accounting for 35.4%, followed by HIV/AIDS with 27.4%. The most common anatomical site for pressure ulcers was tronchanteric region with 43% of the ulcers. Pressure ulcers of grade III and IV accounted for 66.4% of the ulcers. Two hourly turning was the most common method of pressure dispersion used. Gauze dressing was the most common method used in wound care while 67.3% of the patients had their wounds cleaned with povidoneiodine. Fasciocutaneous flaps were the most common surgical procedure performed (81.7%) for closure of pressure ulcers. Overall, 59.3% of surgical procedures had been successful at one month. This was, however, reduced to 48.1% at three months. Conclusion: Majority of patients with pressure ulcers were in a relatively young age group with a mean age of 38 years. Most of the ulcers were located along bony prominence points of the pelvic girdle and the proximal femur. Most of the ulcers in this study were treated conservatively, with only a few ulcers subjected to surgical interventions. For the ulcers treated with surgical interventions the early outcome was good, however studies need to be done to determine long term outcomes.

An Audit of Surgical Management of Pressure Sores in a Resource Constrained Hospital in Kenya

“…While conservative management of advanced pressure sore has been shown to be effective with the use of modern wound dressing materials such as VAC dressings, these materials are way beyond the reach of many patients in such environment. Most dressings employed are usually the traditional dressing materials which in many instances would result in prolonged hospital stays with long durations before the wounds heal [3]. On the other hand surgery ensures quick closure of the wounds enabling faster rehabilitation and hence prompts discharge of the patients.…”

“…Painting the wound with methylene blue as done in this study assists one to visualize the ulcer base. All the bony pressure points should also be excised [1][2][3]. The wound should then be covered by a flap.…”

“…Many series have shown sacral sores to be the commonest pressure sore [3][4][5]. Majority of these sores were closed with either the V-Y gluteal fasciocutaneous or myocutaneous flaps.…”

“…Many authors have reported different success rates [1][2][3]16]. The overall long term success is obviously influenced by many other nonsurgical factors such as physiotherapy, nutritional support, pressure dispersion methods, and patient support mechanisms both at home 4 ISRN Plastic Surgery and in hospital.…”

“…Different authors have reported different success rates as far as closure of the ulcers is concerned [2,3].…”