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What To Expect From Surgical Debridement Of Bed Sores

Almost 28 percent of residents in long-term care facilities in the United States suffer from pressure ulcers or bed sores, and the resulting mortality rate is 68 percent in some settings.

Stage I and stage II pressure sores usually heal within several weeks to months with conservative care of the wound and with ongoing, appropriate general care that manages risk factors for pressure sores, according to the Mayo Clinic.

Stage III and IV pressure sores are more difficult to treat. In a person who has a terminal illness or multiple chronic medical conditions, pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound

For patients with stage III or IV ulcers, treatment is directed toward prevention and management of secondary complications — especially sepsis, a blood infection —and promotion of wound healing. Hospital admissions due to pressure soars increased by 63 percent over a 10-year period, and septicemia is the most common admitting diagnosis, according to a study reported in the World Journal of Surgery.

Debridement, or removal of devitalized tissue, is necessary for wound healing, because moist dead tissue provides a medium for infection that triggers an inflammatory response and eventually results in impaired wound healing. Sharp debridement removes this source of infection and sepsis. Small or superficial wounds can be debrided at the bedside, but debridement in the operating room is often necessary for stage III and IV ulcers.

During surgical debridement, a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the bed sore. This procedure may be accompanied by ‘flap reconstruction,’ which is the use of tissue harvested from a healthy area of the person’s body to cover the open wound. The goal of reconstruction is to improve the hygiene and appearance of the wound and reduce the risk of infection.

Surgical debridement of bed sores has one of the highest complication rates of any surgical procedure. Recovery from the procedure is time intensive and painful. Therefore, the use of surgical debridement to treat bed sores is usually considered to be a last resort.

A small study in 2009, published in the World Journal of Surgery, showed that debridement is safe and may help prevent sepsis and death in patients with multiple conditions. Operative reports for 142 consecutive debridements from 60 patients were reviewed for this study. All patients were treated at a single university-based, tertiary care hospital by a single surgeon and admitted to a dedicated wound healing inpatient unit from January 2004 to December 2006.

In this study, there was one death nine days post-debridement of a lower back ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement.

According to the Center for Medicaid and Medicare Services, the average hospital charge per pressure ulcer patient exceeds $43,000. The cost to acute care hospitals has increased significantly in light of an announcement by the CMS that classified severe pressure ulcers developed in the hospital as a “never event,” and consequently care for these hospital-acquired stage III or IV pressure ulcers will no longer be reimbursed.

For more on senior medical issues, see the library or articles by Daytona Beach nursing home injury attorney.



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