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The patient, a 39-year-old female, suffered a cerebrovascular accident. Due to decreased mobility and extended periods of sitting upright, she developed a stage 4 pressure ulcer over the right ischium. The wound measured 6 cm x 10 cm and extended through the muscle to bone. A smaller stage 4 pressure ulcer, 5 cm in diameter, was present over the left ischium. The family cared for these wounds at home with saline wet-to-moist gauze dressing changes.
The patient was admitted to the neurosurgery service for follow-up of the associated neurological complications of the pressure ulcers. After two weeks of wet-to-moist saline dressing changes three times a day, she was referred to plastic surgery for evaluation of the ischial ulcers. Complicating the poor wound healing was a compromised nutritional status requiring frequent nasogastric feedings.
Surgical closure of the pressure ulcers was ruled out because the patient was a risk for anesthesia. The larger ulcer was treated with the Vacuum Assisted Closure (VAC) System. Wet-to-moist dressing changes were continued on the smaller ulcer. A pressure-relieving support system (KinAir) was ordered to reduce interface pressures and provide comfort. The necrotic soft tissue and bone were debrided at the bedside. After 10 weeks of treatment with the VAC, granulation tissue was flush with the wound margin. The remaining 1 cm x 2 cm area re-epithelialized without further VAC treatment. No systemic complications were encountered.
Throughout the treatment and healing of the large ulcer, the 5 cm left ischial ulcer remained unchanged in size. Wet-to-moist dressing changes were discontinued, and the VAC was applied to this wound, which healed in four weeks.