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Evidence-Based Medicine: The Evaluation and Treatment of Pressure Injuries

Ricci, Joseph A. M.D.; Bayer, Lauren R. P.A.-C.; Orgill, Dennis P. M.D., Ph.D.

Plastic and Reconstructive Surgery: January 2017 - Volume 139 - Issue 1 - p 275e-286e
doi: 10.1097/PRS.0000000000002850
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Learning Objective: After studying this article, the participant should be able to: 1. Discuss the approach to and rationale for pressure injury management, including specific techniques for prevention and preoperative evaluation. 2. Develop a management algorithm for these wounds that includes operative and nonoperative modalities. 3. Understand how to identify and manage the complications of surgical intervention for pressure injuries, including recurrence.

Summary: Pressure injuries are a common problem associated with great morbidity and cost, often presenting as complex challenges for plastic surgeons. Although the cause of these wounds is largely prolonged pressure, the true pathogenesis involves many other factors, including friction, shear, moisture, nutrition, and infection. This article outlines a systematic approach to evaluating and staging pressure injuries, and provides strategies for treatment and prevention. Critical to surgical intervention is thorough débridement, including any involved or causative bony tissues, and postoperative management to prevent wound dehiscence and recurrence.

Boston, Mass.

From the Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School.

Received for publication August 21, 2015; accepted December 29, 2015.

Disclosure:Dr. Orgill is a consultant for Kinetic Concepts, Inc. The other two authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Dennis P. Orgill, M.D., Ph.D., Division of Plastic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, Mass. 02115, dorgill@partners.org

Copyright © 2016 by the American Society of Plastic Surgeons