Tuesday, January 27, 2009

Pressure Ulceration

Back in the summer of 2003, my wife noticed a skin abnormality on my backside. I thought nothing of it and kept on working. After a month or so passed and it was a bit worse, my wife called for some nursing care. They came over two times per week and dressed it. I felt no pain and because I could not see it, I blew the whole thing off. BIG MISTAKE. Well, the wound continued to get worse. Both my wife and my nurse were totally grossed out. I began to get nervous.

We tried putting a vacuum pump type device on it to remove any fluid and dead tissue. It worked very well at first. One day, the only thing being removed was a Black Fluid. It was pretty disgusting. My nurse got very nervous and sent us to a plastic surgeon. He took one look and told me that surgery was necessary. He wanted to do a Flap Job. That is a type of skin graft where they take a High Tech Meat Slicer and remove a portion of skin from a nearby healthy part of your body leaving a piece attached. They then flap the detached portion of the skin over to the wound, place it in the wound and seal me up. The portion that was left attached was to allow for blood flow into the wound. I am not a doctor. That is my best explanation

The surgery went very well and all of the people in the hospital told me how nice my backside was. What can I say? However, after the surgery and for the next three years, I continued to have small-scale skin eruptions, mostly because I dropped a lot of weight in the hospital. I stopped eating because the hospital food was incredibly bad. Just Raisin Bran and Italian Ice. The last wound healed exactly 631 days ago. Not a day goes by where I am not worried.

How did this happen? To start off, I am a wheelchair user and can not adjust my position. Secondly, and most importantly I sit at my desk all day working. At the time, I was using a terrible cushion to sit on. I did that because I needed to be lower relative to my desk. Why did everything happen ? Well, I have always been very aggressive at my job. I take it very seriously. I lean forward on my desk to type on my computer, take notes and speak on my telephone.. When you lean forward like that, pressure occurs between the skin on your backside and the ischial (sp) bone. Constant pressure with no movement or blood flow in the tissue essentially kills it. The skin rips open and you have a problem. Now, I do not lean on my desk , use Dragon Naturally Speaking and things i are quite stable . This is as simple and laymen like as I could put it.

Below is a description for you:

Pressure Ulcers(Pressure sores; Bedsores; Decubitus Ulcers; Decubiti)

The Merck Manual Minute

Pressure ulcers are areas of necrosis and ulceration where tissues are compressed between bony prominences and hard surfaces; they result from pressure alone or pressure in combination with friction, shearing forces, or both. Risk factors include old age, impaired circulation, immobilization, malnourishment, and incontinence. Severity ranges from nonblanchable skin erythema to full-thickness skin loss with extensive soft-tissue necrosis. Diagnosis is clinical. Treatment includes pressure reduction, avoidance of friction and shearing forces, local care, and sometimes skin grafts or myocutaneous flaps. Prognosis is excellent for early-stage ulcers; neglected and late-stage ulcers pose risk of serious infection and nutritional stress and are difficult to heal.


An estimated 1.3 to 3 million patients in the US have pressure ulcers (PUs); incidence is highest in older patients, especially those who are hospitalized or in long-term care facilities. Aging increases risk, in part because of reduced subcutaneous fat and decreased capillary blood flow. Immobility and comorbidities increase risk further.

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