Older Patients With Multiple Conditions, Ulcer Wounds Require Multidisciplinary Treatment Approach

Treatment of wounds resulting from surgical removal of multisite pressure ulcers (PUs) proved difficult in elderly patients with multiple medical conditions, according to a recent study that stressed the importance of establishing a multidisciplinary team when making treatment decisions.

The study, published in Clinical, Cosmetic and Investigational Dermatology, highlighted the challenges providers face when choosing the appropriate wound treatment method for elderly patients, who are more likely to have several other conditions, such as type 2 diabetes, anemia, hypoproteinemia, tumors, and cardiovascular and cerebrovascular diseases.

PUs are caused by long-term pressure on skin tissues, impaired blood flow, tissue ischemia, and necrosis resulting from extreme hypoxia. PU incidence is positively correlated with age and is gradually increasing in China because a large part of the population is becoming elderly.

Caring for the wounds of elderly patients can difficult because they may have trouble turning over on their own and lack of mobility may cause PUs to develop at multiple sites. Additionally, long-term hormone medication, skin thinning over time, and immunosuppressive states are correlated with PU treatments complications.

The investigators examined 52 elderly patients with several medical conditions and PUs in the sacrococcygeal region of the buttocks who were admitted to Dalang Hospital of Dongguan in Dongguang, China from January 2016 to October 2020 to observe the impacts of different treatment options for multisite PU at various stages.

There were 18 male and 34 female patients who were between the ages of 62 and 93 years. There were 52 PUs in the sacrococcygeal region and 43 PUs in 2 or more locations ranging in severity.

Stage 3 and 4 PUs were treated by removing any thick hard scabs of necrotic skin and subcutaneous tissue that formed for better infection control, flap transfer repairs if granulations grew properly, and a combination of closed negative pressure suction and continuous micro-oxygen profusion.

Flap or myocutaneous flap repair was performed in 34 PUs that were at stage 3 or 4 in the sacrococcygeal area, of which 28 achieved primary healing, 6 required additional surgeries, and 5 received micro-skin implantation. In 10 small deep PUs in other site required direct excision and suturing or local flap repair. Seven cases transferred to other departments or hospitals or were discharged without surgical treatment. One case died in the hospital as the result of an illness.

The investigators found that there was a linear trend between pressure ulcer stage and the effect of the therapeutic method (X² = 32.86; P < .001). Also, the effectiveness of a method decreased as the pressure ulcer severity increased.

The investigators also warned about the dangers of neglecting management for lower-grade ulcers, such as stage 1 and 2 PUs, which are often overlooked until they progress to more severe levels.

“It is necessary to treat the primary disease, correct anemia and hypoproteinemia promptly, control blood glucose and blood pressure within normal ranges, and create good conditions for surgery. While actively making preoperative preparations for the stage 3 and 4 PU, conservative treatment of stage 1 and 2 PU in other areas should not be neglected,” said the investigators.

Limitations of the study included the small sample size and the focus on a single medical center. The investigators said that future randomized controlled trials should be carried out to better evaluate the efficacy of the treatment methods.

Reference

Su S, Ding X, Zou H, et al. Wound management of multi-site pressure ulcer at different stages in elderly patients. Clin Cosmet Investig Dermatol. Published online June 29, 2021. doi:10.2147/CCID.S316694