Pressure sores with associated spasticity: a clinical challenge

Abstract

Paraplegic and quadriplegic patients particularly those suffering from spinal cord injuries are at a high risk of developing pressure ulcerations. Unlike pressure ulcers in geriatric patients, which usually can be controlled with pressure relieving devices and local wound care, pressure ulceration complicating spinal cord injuries should be viewed from another perspective. Clinical management is also more complex because of the associated spasticity. Although it is now recognised that spasticity control is critical for management of patients with cerebral or spinal cord diseases or injuries, published risk assessment studies and risk assessment pressure sore scales fail to recognise spasticity as a major risk factor. Identification of spasticity should heighten the awareness of medical and paramedical personnel and have a positive impact on prevention as well as on treatment of pressure sores in this particularly difficult group of patients. We present our experience with a young quadriplegic patient with severe spasticity presenting with a large infected ischial pressure sore. All surgical as well as conservative attempts to achieve healing failed because of our failure to recognise the importance of spasticity control in the overall treatment scheme. Spasticity control should be included as a prerequisite for any treatment protocol of such patients.

Figure 1. Wound dehiscence at the superior medial aspect of the VY hamstring myocutaneous flap. Site of original ischial pressure sore is indicated by a circle. Arrow indicates the scar of the healed gluteus maximus flap performed several years earlier to cover a sacral pressure sore