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A case study of an obese patient with a large sacral pressure ulcer

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Case Study of an Obese Patient with a Large Sacral Pressure Ulcer

A Andriessen1, R van Dam2, A van den Wijngaard3

1. PhD, UMC St Radboud Nijmegen & Andriessen Consultants, Malden, The Netherlands.  2. RN, Pressure Ulcer Specialist, Verpleeghuis Boerhaave Stichting Sint Jacob 2035 RJ  Haarlem, The Netherlands.

3. RN, CNS, Wound Care and Compression Specialist, Lohmann & Rauscher, Almere, The Netherlands  

Aim:

Although education on pressure ulcer prevention has improved, extensive pressure ulcers do occur, especially in complex situations such as obesity.

The aim was to provide tailor made solutions to achieve an optimal outcome.

Methods:

üCase ascertainment was used addressing the complex psychological and physical issues that arise in the 64-years old obese male.
üHis weight was 160 kg and his height was 1.70 meter.
üIn a short period of time he had lost 50 kg for no obvious reason.
üHe lived alone, was inactive, incontinent of both urine and faeces and spent most of his time sitting in a chair.
üHe had developed a class 3 (EUPAP classification) sacral pressure ulcer that was initially unsuccessfully treated at home.

Results:

Upon admission to the hospital, surgical debridement was performed leaving an ulcer of 21 x 15 x 6 cm. During hospital stay 2 grade 4 heel ulcers developped. After 1 month he was transfered to a nursing home, where he received an air matress and foam to off-load his heels. He received education on his condition and a dietician was consulted.

The heel ulcers measured 8 x 8 cm and had black necrosis, which was debrided.

Both legs were swollen with oedema, which was adressed with compression bandages.

Sacral ulcer closure was achieved within 13.5 weeks and the heel ulcers had markedly improved.

Conclusion :

Adressing specific patient issues combined with optimal wound care was shown to be succesful.

 

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