Decubitius Ulcer

[monica f]

This week I found a stage 2-3 decubitius ulcer on the great toe of my 4 year old pediatric patient. This was caused from a pulse ox probe being place on the toe for 3 days and not being checked or moved. There is an ulcer on the inner and outer aspect of the toe. We have tried to place cotton between the toes and of coorifice the pulse ox is no longer on that foot. Unfortunetly the toe is not healing very well. Does anyone have any ideas on how to protect the ulcer to promote healing?

[athul]

I am a nursing student at the University of Minnesota and as part of an assignment I did a literature review of your question. I found several articles that may be helpful. Burke, Ho, Bchir, Saucier and Stewart (1998) studied the effects of hydrotherapy as a method of debridement on pressure ulcer healing. All participants in the study received wet-to-dry dressing changes twice a day and when teh dressings were soiled. In addition, the hydrotherapy group receivedtwenty minutes of whirlpool therapy using 96 to 98 degree water. Burke, Ho, Bchir, Saucier and Stewart (1998) found their data to support hydrotherapy as a beneficial treatment for pressure ulcers. A daily twenty minute soak of the affected foot may be an easy way to incorporate hydrotherapy.

Karadakovan and Basbakkal (1997) studied ice therapy as a treatment for pressure ulcers. They describe the physiological effect of ice therapy as causing alternating periods of local vasoconstriction and vasodilation. The vasoconstriction reduces swelling in the area while periods of vasodilation allow more of teh components needed for healing to be brought to the area. The ice therapy consisted of placing ice cubes in a waterproof bag, covering teh area withh a thin layer of sterile gauze, applying the ice for four minutes, and finally cleaning the wound with Betadine and applying a sterile dressing (Karadakovan & Basbakkal, 1997). They found that the ice therapy contributed to teh healing of grade two pressure ulcers and that it was not detrimental to any of the participants.

I also found two articles dealing witht the types of dressings used to treat pressure ulcers. Mosher, Cuddigan, Thomas, and Boudraeu (1999) studied four types of dressings with regards to their debridement of the ulcer. They studied wet-to-dry, autolysis, fibrinolysis and collagenase dressings. They found that collagenase both produced better patient outcomes and was more cost effective in the treatment of pressure ulcers (Mosher, Cuddigan, Thomas, & Boudreau, 1999). The other articale studied the use of a new dressing which incorporates the active ingredient in aloe vera, acemannan, in a hydrogel dressing (Thomas, Goode, LaMaster, & Tennyson, 1998). Thomas, Goode, LaMaster and Tennyson (1998) found this dressing to be, "as effective, but not superior to, a moist saline gauze wound dressing for the management of pressure ulcers." This may be another alternative to try with your patient.

References:

Burke, D T, Ho, C H, Bchir, M B, Saucier, M A, & Stewart, G. (1998). Effect of hydrotherapy on pressure ulcer healing. American Journal of Physical Medicine and Rehabilitation. 77, 394-398.

Karadakovan, A, & Basbakkal, Z. (1997). Ice therapy for pressure sores. Rehabilitation Nursing. 22, 257-258.

Mosher, B A, Cuddigan, J, Thomas, D R, & Boudreau, D M. (1999). Outcomes of 4 methods of debridement using a decision analysis methodology. Advances in Wound Care. 12(supplement 2), 12-21.

Thomas, D R, Goode, P S, LaMaster, K, & Tennyson, T. (1998). Acemannan hydrogel dressing for pressure ulcers: A randomized, controlled trial. Advances in Wound Care. 11(6), 273-276.