Canis ISSN: 2398-2942

Skin: decubital ulcers

Synonym(s): Pressure sores, bed sores

Contributor(s): Gillian Calvo, Grayson Cole

Introduction

  • A decubital ulcer can be defined as a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure.
  • Cause: a large amount of pressure over a short period of time, or a small amount of pressure over a prolonged time typically in recumbent patients. Ischemia and reperfusion injury is thought to be involved in the pathophysiology.
  • Signs: can vary in severity from patches of discolored or hyperemic skin to open wounds with or without exposure of underlying muscle and/or bony tissues. 
  • Diagnosis: visual examination.
  • Treatment: supportive/physical therapy.
  • Prognosis: dependent upon the grade of the ulcer and response to treatment and ability to treat underlying cause of recumbency.
Print off the owner factsheet Care of the recumbent or paralysed dog to give to your client.

Pathogenesis

Etiology

  • Sustained pressure of skin over bony prominence causing interruption of blood supply to a specific area resulting in progressive and potentially chronic ischemia.
  • Pressure inhibits oxygenation and nutrition to the tissues.
  • Ischemia and reperfusion causes further injury as the reperfusion leads to reactive oxygen species and cellular edema.

Intrinsic risk factors

  • Mobility problems due to orthopedic, neurologic or systemic diesase.
  • Poor nutritional or general health status.
  • Concurrent health issues (circulatory compromise), eg diabetes mellitus, renal disease or cardiac disease.
  • Geriatric life stage: aging skin, loss of elasticity and loss of body fat and muscle tone.
  • Urinary and/or fecal incontinence; increased moisture on skin.
  • Abnormal sensation which can occur with spinal injury or other neurological disease.

Extrinsic risk factors

  • Pressure from hard or abrasive surfaces.
  • Poor nursing care including lack of frequent position changes.
  • Accumulation of moisture related to urine or fecal scalding or wound exudate.

Predisposing factors

General

  • Patients vulnerable to decubital ulcers include:
    • Recumbent patients.
    • Patients with reduced ability or inability to adjust their position.
    • Debilitated or paralyzed dogs.
    • Patients with concurrent health conditions resulting in compromised circulation.
    • Larger dogs due to greater body weight.
    • Areas of body with reduced coverage of body fat.
    • Areas in direct contact with a supporting surface.

Timecourse

  • The exact timecourse is difficult to determine as pressure ulcers may occur secondary to repetitive or prolonged pressure.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Li W (2017) Moist exposed burn ointment for treating pressure ulcers. A multicenter randomized controlled trial. Medicine 96, 29 (e7582) PubMed.
  • Polak A (2017) The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial. Phys Ther 97 (8), 777-789 PubMed.
  • Yamada H (2017) Skin stiffness determined from occlusion of a horizontally running microvessel in response to skin surface pressure: a finite element study of sacral pressure ulcers. Med Biol Eng Comput 55, 79-88 PubMed.
  • Yapp J H (2017) Trends of reactive hyperaemia responses to repetitive loading on skin tissue of rats. J Tissue Viability 26, 196e201 PubMed
  • Ahmed A K (2016) A non-invasive method to produce pressure ulcers of varying severity in a spinal cord-injured rat model. Spinal Cord  54, 1096-1104 PubMed.
  • Bonne C (2016) Potential efficiency of antioxidants to prevent pressure ulcers. A neglected hypothesis. Medical Hypotheses 91, 28-31 PubMed.
  • Cui F-F et al (2016) Pressure Combined with Ischemia/Reperfusion Injury Induces Deep Tissue Injury via Endoplasmic Reticulum Stress in a Rat Pressure Ulcer Model. Int J Mol Sci 17, 284 PubMed.
  • Hao D F (2015) Evaluation of effectiveness of hydrocolloid dressing vs ceramide containing dressing against pressure ulcers. Eur Rev Med Pharmacol Sci 19, 936-941 PubMed.
  • Lupiañez-Perez I et al (2015) Topical Olive Oil Is Not Inferior to Hyperoxygenated Fatty Aids to Prevent Pressure Ulcers in High-Risk Immobilised Patients in Home Care. Results of a Multicentre Randomised Triple-Blind Controlled Non-Inferiority Trial. PLoS One 10 (4), e0122238 PubMed.
  • Tambella A M (2014) Autologous Platelet Gel to Treat Chronic Decubital Ulcers: A Randomized, Blind Controlled Clinical Trial in Dogs. Vet Surg 43, 726-733 PubMed.

 


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