Difference between revisions of "Pressure ulcer"
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==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: | ||
Revision as of 07:54, 24 July 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.
General
Etiology:
Microscopic
Features:
- Ulceration - full thickness loss of the epidermis.
- Epidermal thickening (acanthosis and hyperkeratosis) adjacent to ulcer - pseudoepitheliomatous hyperplasia.[5]
- 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.[6]
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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.
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.
- ↑ 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.