TREATMENT OF PRESSURE ULCERS OF THE SCALP IN DECOMPENSATED HYDROCEPHALY: A CLINICAL CHALLENGE.
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Highlights:
- Studies of pressure injury in hydrocephalus patients are very limited.
- To determine the staging and diagnosis, clinicians must consider the anatomical location of pressure injury, especially in children.
- Pressure injury increases the risk of shunt infection in hydrocephalus patients.
Abstract:
Introduction: A pressure injury is ‘localized injury to the skin and/or underlying tissue usually over a bony prominence, that caused by compression. Multiple studies have demonstrated that age, moisture, immobility, and friction/shear are key risk factors. We report a challenging case of multiple pressure injury over the scalp in hydrocephalus patients.
Case Illustration: Three toddlers with Hydrocephalus was consulted due to multiple Pressure Injury over the scalp in the bilateral temporo-parietal and occipital region. After ventriculo-peritoneal shunting (VP-shunt), the wounds were managed in accordance with TIMERS guidelines.
Discussion: Pediatric tissues are more susceptible to deformation injuries. Severe skull deformity and macrocephaly are serious problems that may lead to difficulties in head control and child positioning increases the risk of pressure injury. After VP-shunt, wound care is even more challenging since the surgical wound is closely related to pressure injuries. Shunt exposure can be occurred on these patients. According to both examination and intervention of TIMERS guidelines are essential as well as controlling risk factors of pressure injury development.
Conclusion: Surgeons should be aware that children with hydrocephalus may experience scalp injuries and changes to their body composition, which challenge the diagnosis and care process.
Delmore B, Deppisch M, Sylvia C, Luna-Anderson C, Nie AM. Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Adv Skin Wound Care [Internet]. 2019 Sep;32(9):394–408. Available from: https://journals.lww.com/10.1097/01.ASW.0000577124.58253.66
Shahin ESM, Meijers JMM, Schols JMGA, Tannen A, Halfens RJG, Dassen T. The relationship between malnutrition parameters and pressure ulcers in hospitals and nursing homes. Nutrition. 2010 Sep 1;26(9):886–9.
Pascal E, Scott AR. Posterior scalp pressure injury among pediatric head and neck surgical patients. Int J Pediatric Otorhinolaryngology. 2020 May 1;132.
Levy A, Kopplin K, Gefen A. Adjustability and Adaptability Are Critical Characteristics of Pediatric Support Surfaces. Adv Wound Care (New Rochelle). 2015 Oct;4(10):615–22.
Freundlich K. Pressure injuries in medically complex children: A review. Vol. 4, Children. MDPI; 2017.
Shuk-Fan T, Joanne Y, Kit-Lun Y, Marcus Chun-Wah Y. Pressure Ulcer Wound Care for Elderly in Home: A Case Report. Journal of Dermatology Research and Therapy. 2016 Jun 30;2(3).
Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatology. 2019 Oct 1;81(4):881–90.
Sanada H, Sugama J, Kitagawa A, Thigpen B, Kinosita S, Murayama Suriadi S. Risk factors in the development of pressure ulcers in an intensive care unit in Pontianak, Indonesia. Vol. 4, Int Wound J. 2007.
Amir Y, Halfens R, Lohrmann C, Schols J. Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital. J Wound Care. 2013;22(5):254–60.
Kale ED, Nurachmah E, Pujasari H. The Use of Braden Scale Proven Effective in Predicting the Incident of Pressure Ulcer. Jurnal Keperawatan Indonesia. 2014 Nov 30;17(3):95–100.
Faghih Jouibari M, Baradaran N, Shams Amiri R, Nejat F, El Khashab M. Huge hydrocephalus: Definition, management, and complications. Child's Nervous System. 2011 Jan;27(1):95–100.
Friis-Hansen B. Body composition during growth. In vivo measurements and biochemical data correlated to differential anatomical growth. Pediatrics. 1971 Jan;47(1): Suppl 2:264+.
Debernard L, Robert L, Charleux F, Bensamoun SF. Analysis of thigh muscle stiffness from childhood to adulthood using magnetic resonance elastography (MRE) technique. Clin Biomech (Bristol, Avon). 2011 Oct;26(8):836–40.
Zhu YH, Song SP, Luo W, Elias PM, Man MQ. Characterization of skin friction coefficient, and relationship to stratum corneum hydration in a normal Chinese population. Skin Pharmacology Physiology. 2011;24(2):81–6.
Finbråten AK, Martins C, Andersen GL, Skranes J, Brannsether B, Júlíusson PB, et al. Assessment of body composition in children with cerebral palsy: A cross-sectional study in Norway. Dev Med Child Neurology. 2015 Sep 1;57(9):858–64.
Bhattacharya S, Mishra RK. Pressure ulcers: Current understanding and newer modalities of treatment. Indian Journal of Plastic Surgery. 2015 Jan 26;48(01):004–16.
Black J, Baharestani M, Cuddigan J, Dorner B, Edsberg L, Langemo D, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Vol. 19, Dermatology nursing / Dermatology Nurses' Association. 2007.
Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Journal of Wound, Ostomy and Continence Nursing. 2016 Nov 28;43(6):585–97.
Shuk-Fan T, Joanne Y, Kit-Lun Y, Marcus Chun-Wah Y. Pressure Ulcer Wound Care for Elderly in Home: A Case Report. Journal of Dermatology Research and Therapy. 2016 Jun 30;2(3).
Serra R, Grande R, Buffone G, Gallelli L, Caroleo S, Tropea F, et al. Albumin administration prevents the onset of pressure ulcers in intensive care unit patients. Int Wound J. 2015 Aug 1;12(4):432–5.
Bhattacharya S, Mishra R. Pressure ulcers: Current understanding and newer modalities of treatment. Vol. 48, Indian Journal of Plastic Surgery. Medknow Publications; 2015. p. 4–16.
Caroline D, Elizabeth A. TIME principles of chronic wound bed preparation and treatment. British journal of nursing and treatment. 2004;13(15):16–23.
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