Operative debridement of pressure ulcers

Jessica Schiffman, Michael S. Golinko, Alan Yan, Anna Flattau, Marjana Tomic-Canic, Harold Brem

Research output: Contribution to journalReview article

39 Scopus citations

Abstract

Background: Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%. Methods: Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement. Results: The mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm2, and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement. Conclusions: Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions.

Original languageEnglish (US)
Pages (from-to)1396-1402
Number of pages7
JournalWorld Journal of Surgery
Volume33
Issue number7
DOIs
StatePublished - Jul 2009

ASJC Scopus subject areas

  • Surgery

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    Schiffman, J., Golinko, M. S., Yan, A., Flattau, A., Tomic-Canic, M., & Brem, H. (2009). Operative debridement of pressure ulcers. World Journal of Surgery, 33(7), 1396-1402. https://doi.org/10.1007/s00268-009-0024-4