Difference between revisions of "Pressure ulcer"
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'''Pressure ulcer''', also known as '''decubitus ulcer''' (as it often arises from lying down, i.e. being decubitus, a long time), is a relatively common [[ditzel]]. | '''Pressure ulcer''', also known as '''decubitus ulcer''' (as it often arises from lying down, i.e. being decubitus, a long time), is a relatively common [[ditzel]]. | ||
Ulcers overlying the ischial tuberosity (ischial ulcers) are pressure ulcers. | |||
==General== | ==General== | ||
*Common, esp. in spina bifida,<ref name=pmid21129225>{{Cite journal | last1 = Nthumba | first1 = PM. | title = Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. | journal = World J Surg Oncol | volume = 8 | issue = | pages = 108 | month = | year = 2010 | doi = 10.1186/1477-7819-8-108 | PMID = 21129225 }}</ref> individuals with spinal cord injuries. | *Common, esp. in spina bifida,<ref name=pmid21129225>{{Cite journal | last1 = Nthumba | first1 = PM. | title = Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. | journal = World J Surg Oncol | volume = 8 | issue = | pages = 108 | month = | year = 2010 | doi = 10.1186/1477-7819-8-108 | PMID = 21129225 }}</ref> individuals with spinal cord injuries.<ref name=pmid22316632>{{Cite journal | last1 = Schessel | first1 = ES. | last2 = Ger | first2 = R. | last3 = Oddsen | first3 = R. | title = The costs and outcomes of treating a deep pressure ulcer in a patient with quadriplegia . | journal = Ostomy Wound Manage | volume = 58 | issue = 2 | pages = 41-6 | month = Feb | year = 2012 | doi = | PMID = 22316632 }}</ref> | ||
Etiology: | Etiology: | ||
*Mechanical injury.<ref name=pmid20299616>{{Cite journal | last1 = Olesen | first1 = CG. | last2 = de Zee | first2 = M. | last3 = Rasmussen | first3 = J. | title = Missing links in pressure ulcer research--an interdisciplinary overview. | journal = J Appl Physiol | volume = 108 | issue = 6 | pages = 1458-64 | month = Jun | year = 2010 | doi = 10.1152/japplphysiol.01006.2009 | PMID = 20299616 }}</ref><ref name=pmid15157010>{{Cite journal | last1 = Hamanami | first1 = K. | last2 = Tokuhiro | first2 = A. | last3 = Inoue | first3 = H. | title = Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury. | journal = Acta Med Okayama | volume = 58 | issue = 1 | pages = 37-44 | month = Feb | year = 2004 | doi = | PMID = 15157010 }}</ref> | *Mechanical injury.<ref name=pmid20299616>{{Cite journal | last1 = Olesen | first1 = CG. | last2 = de Zee | first2 = M. | last3 = Rasmussen | first3 = J. | title = Missing links in pressure ulcer research--an interdisciplinary overview. | journal = J Appl Physiol | volume = 108 | issue = 6 | pages = 1458-64 | month = Jun | year = 2010 | doi = 10.1152/japplphysiol.01006.2009 | PMID = 20299616 }}</ref><ref name=pmid15157010>{{Cite journal | last1 = Hamanami | first1 = K. | last2 = Tokuhiro | first2 = A. | last3 = Inoue | first3 = H. | title = Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury. | journal = Acta Med Okayama | volume = 58 | issue = 1 | pages = 37-44 | month = Feb | year = 2004 | doi = | PMID = 15157010 }}</ref> | ||
==Gross== | |||
Typical locations: | |||
*Ischial tuberosity. | |||
*Sacrum.<ref name=pmid19060829>{{Cite journal | last1 = Beldon | first1 = P. | title = Problems encountered managing pressure ulceration of the sacrum. | journal = Br J Community Nurs | volume = 13 | issue = 12 | pages = S6, S8, 10 passim | month = Dec | year = 2008 | doi = | PMID = 19060829 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Ulceration - full thickness loss of the epidermis. | *Ulceration - full thickness loss of the epidermis. | ||
*Epidermal thickening ([[acanthosis]] and [[hyperkeratosis]]) adjacent to ulcer - [[pseudoepitheliomatous hyperplasia]].<ref name=pmid21399447>{{Cite journal | last1 = Zayour | first1 = M. | last2 = Lazova | first2 = R. | title = Pseudoepitheliomatous hyperplasia: a review. | journal = Am J Dermatopathol | volume = 33 | issue = 2 | pages = 112-22; quiz 123-6 | month = Apr | year = 2011 | doi = 10.1097/DAD.0b013e3181fcfb47 | PMID = 21399447 }}</ref> | |||
*Inflammation - lymphocytes, plasma cells, [[neutrophils]]. | *Inflammation - lymphocytes, plasma cells, [[neutrophils]]. | ||
*+/-Abscess formation - clusters of extravascular neutrophils. | *+/-Abscess formation - clusters of extravascular neutrophils. | ||
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<pre> | <pre> | ||
SKIN LESION ("DECUBITUS ULCER"), EXCISION: | SKIN LESION ("DECUBITUS ULCER"), EXCISION: | ||
- SKIN | - ULCERATED SKIN WITH ACANTHOSIS, HYPERKERATOSIS, PARAKERATOSIS, AND CHRONIC | ||
ACTIVE INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER. | |||
- NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR MALIGNANCY. | ||
</pre> | |||
<pre> | |||
SKIN LESION ("DECUBITUS ULCER"), EXCISION: | |||
- ULCERATED SKIN WITH PSEUDOEPITHELIOMATOUS HYPERPLASIA AND CHRONIC ACTIVE | |||
INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
LESION ("LEFT ISCHIAL ULCER"), EXCISION: | |||
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
LESION ("RIGHT ISCHIAL ULCER"), EXCISION: | |||
- ULCERATED SKIN WITH EPIDERMAL HYPERPLASIA, AND DERMAL AND SUBCUTANEOUS TISSUE WITH | |||
CHRONIC INFLAMMATION. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
LESION ("SACRAL ULCER"), EXCISION: | |||
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES, MICROABSCESS | |||
AND GRANULATION TISSUE. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | </pre> | ||
====Micro==== | ====Micro==== | ||
The sections show skin with acanthosis, hypergranulosis, compact hyperkeratosis and focal full thickness loss of the epidermis, associated with a mixed inflammatory infiltrate. The dermis has reactive fibroblasts with moderate grey cytoplasm, nuclear enlargement and round small nucleoli. Fibroblast nuclei have regular nuclear membranes and a bland chromatin pattern. Small clusters of neutrophils are present. Mitotic activity is not apparent. | The sections show skin with acanthosis, hypergranulosis, compact hyperkeratosis and focal full thickness loss of the epidermis, associated with a mixed inflammatory infiltrate. The dermis has reactive fibroblasts with moderate grey cytoplasm, nuclear enlargement and round small nucleoli. Fibroblast nuclei have regular nuclear membranes and a bland chromatin pattern. Small clusters of neutrophils are present. | ||
There is no epidermal nuclear atypia. Mitotic activity is not apparent. | |||
==References== | ==References== | ||
Latest revision as of 19:10, 2 December 2013
Pressure ulcer, also known as decubitus ulcer (as it often arises from lying down, i.e. being decubitus, a long time), is a relatively common ditzel.
Ulcers overlying the ischial tuberosity (ischial ulcers) are pressure ulcers.
General
Etiology:
Gross
Typical locations:
- Ischial tuberosity.
- Sacrum.[5]
Microscopic
Features:
- Ulceration - full thickness loss of the epidermis.
- Epidermal thickening (acanthosis and hyperkeratosis) adjacent to ulcer - pseudoepitheliomatous hyperplasia.[6]
- Inflammation - lymphocytes, plasma cells, neutrophils.
- +/-Abscess formation - clusters of extravascular neutrophils.
DDx:
- Squamous cell carcinoma of the skin.
- Known as a Marjolin's ulcer when arising in the context of long standing inflammation.[7]
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SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH ACANTHOSIS, HYPERKERATOSIS, PARAKERATOSIS, AND CHRONIC
ACTIVE INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH PSEUDOEPITHELIOMATOUS HYPERPLASIA AND CHRONIC ACTIVE
INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
LESION ("LEFT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES.
- NEGATIVE FOR MALIGNANCY.
LESION ("RIGHT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN WITH EPIDERMAL HYPERPLASIA, AND DERMAL AND SUBCUTANEOUS TISSUE WITH
CHRONIC INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
LESION ("SACRAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES, MICROABSCESS
AND GRANULATION TISSUE.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Micro
The sections show skin with acanthosis, hypergranulosis, compact hyperkeratosis and focal full thickness loss of the epidermis, associated with a mixed inflammatory infiltrate. The dermis has reactive fibroblasts with moderate grey cytoplasm, nuclear enlargement and round small nucleoli. Fibroblast nuclei have regular nuclear membranes and a bland chromatin pattern. Small clusters of neutrophils are present.
There is no epidermal nuclear atypia. Mitotic activity is not apparent.
References
- ↑ Nthumba, PM. (2010). "Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients.". World J Surg Oncol 8: 108. doi:10.1186/1477-7819-8-108. PMID 21129225.
- ↑ Schessel, ES.; Ger, R.; Oddsen, R. (Feb 2012). "The costs and outcomes of treating a deep pressure ulcer in a patient with quadriplegia .". Ostomy Wound Manage 58 (2): 41-6. PMID 22316632.
- ↑ Olesen, CG.; de Zee, M.; Rasmussen, J. (Jun 2010). "Missing links in pressure ulcer research--an interdisciplinary overview.". J Appl Physiol 108 (6): 1458-64. doi:10.1152/japplphysiol.01006.2009. PMID 20299616.
- ↑ Hamanami, K.; Tokuhiro, A.; Inoue, H. (Feb 2004). "Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.". Acta Med Okayama 58 (1): 37-44. PMID 15157010.
- ↑ Beldon, P. (Dec 2008). "Problems encountered managing pressure ulceration of the sacrum.". Br J Community Nurs 13 (12): S6, S8, 10 passim. PMID 19060829.
- ↑ Zayour, M.; Lazova, R. (Apr 2011). "Pseudoepitheliomatous hyperplasia: a review.". Am J Dermatopathol 33 (2): 112-22; quiz 123-6. doi:10.1097/DAD.0b013e3181fcfb47. PMID 21399447.
- ↑ Simmons, MA.; Edwards, JM.; Nigam, A. (Dec 2000). "Marjolin's ulcer presenting in the neck.". J Laryngol Otol 114 (12): 980-2. PMID 11177375.