Serial Surgical Debridement of Common Pressure Injuries in the Nursing Home Setting

Outcomes and Findings

Bardia Anvar, MD; Henry Okonkwo, PA-C

Disclosures

Wounds. 2017;29(7):215-221. 

In This Article

Results

Of the 227 patients identified to have 8 or more visits and PIs in the SSCIT region, there were about 319 individual SSCIT wounds, with an average of 1.4 SSCIT wounds per patient. Bedside surgical debridement was performed using a sharp excisional technique on 190 of 319 (59.5%) SSCIT wounds (Figure 3). An analysis of the square surface area of the 190 debrided wound sites revealed a mean ulcer surface area of 20.76 cm2. From the 190 wounds, 138 (73%) had a reduction in square surface area, and 52 (27%) had no improvement or increase in size and were categorized as nonresponders. Of the wounds that did improve by a reduction in wound surface area, the average wound surface area reduction was 6.81 cm2 at 4 weeks (25%), 8.91 cm2 reduction at 8 weeks (33%), and 10.87 cm2 reduction at 12 weeks (40%) (Figure 4). Out of the 190 wound sites, there were a total of 43 (23%) wounds that had a square surface area of 0 (reepithelialized) with a mean healing time of 137 days (23% healing rate).

Figure 3.

Wounds requiring debridement. In total, 59.5% of patients with sacrum, sacrococcyx, coccyx, ischium, and trochanter wounds required debridement.

Figure 4.

Square surface area (cm2) of the wounds with surgical debridement over time. Square surface area of wounds declined the greatest in the first 4 weeks of the debridement period.

Wounds were identified to be either responsive to debridement therapy by a reduction in mean square surface area or nonresponsive. There were 138 responsive sites (73%) versus 52 nonresponsive sites (27%) (Figure 5). Of the 190 sites, 100 (53%) demonstrated a square surface area reduction > 50%.

Figure 5.

Response to debridement. In total, 73% of wound sites had a response to debridement demonstrated by a reduction in size.

The greatest concentration of wounds in this study requiring debridement was located in the sacrococcyx region (n = 66; 35%), with the lowest number located in the trochanter (n = 12; 6%). The odds ratio for responders to nonresponders was 3:1 for ischium, 3:1 for trochanter, 3:1 for sacrococcyx, 3:1 for sacrum, and 2:1 for coccyx. Thus, the odds ratio for coccyx to other sites is 2:3 (67%), making it more than half as likely to improve the coccyx area through debridement than other sites in general.

On average, all wounds in the debridement group received 16.7 debridements. The responder group received an average of 15.7 surgical debridements, and the nonresponder group received 18.2 debridements. The responder group had an average visit count of 19.4 and the nonresponder group had 19.9. For an overall average, patients were seen on a weekly basis for an average of 117.7 days, with a breakdown of 123.8 days for the responder group and 110.6 days for the nonresponder group. Table 1 and Table 2 show the breakdown by wound site, delineating the differences in the average number of visits and debridement to achieve healing.

Further examination revealed the average age of the responder group was 67.56 years and 64.97 years for the nonresponder group. On average, the starting wound surface area was 26.21 cm2 for the responder group and 12.22 cm2 for the nonresponder group. The average starting depth of wounds was 1.33 cm for the responder group and 1.22 cm for the nonresponder group. Enzymatic debriding agents were used during 55% of the visits for the responder group and 62% of the nonresponder group. At the start of treatment, the average amount of granulation tissue for the responder group was 52% and 53% for the nonresponder group; the average amount of necrosis was 13% (responder) and 4% (nonresponder) and slough was 34% (responder) and 40% (nonresponder).

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