Actionable Nuggets for SCI (2nd ed., 2013)
Treat stage I or II wounds with standard wound care. Treat stage III or IV wounds with specialist / surgical intervention.
Approximately 75% of pressure ulcers in the SCI population are Stage I or II, and can be managed conservatively. The remaining 25% are Stage III or IV, and require more specialized management. Severe pressure ulcers can lead to decreased mobility, loss of independence, amputation, and even fatal infections. Pressure ulcers are most effectively treated when diagnosed and treated early.
Additional information: International classification for wound care
Evidence-based Best Practice:
Standard wound care for Stage I and II ulcers includes cleansing, debridement, and pressure dressing. Promising results have been found with occlusive hydrocolloid, electrical stimulation, powdered arginine, and platelet gel, all of which can be administered by a wound care team in the community. Early intervention, self-management training and decision support are all recommended. Referral to rehabilitation is also recommended for seating and preventive strategies. Referral to a dietician may be beneficial, since nutritional status can significantly affect healing, especially energy and protein needs.
Surgical management is recommended for Stage III and IV ulcers, and has been shown to have significant positive effects on wound healing and quality of life. Telephone and video conferencing have been highly effective in making specialized wound care more accessible, with good rates of agreement with in-person assessment.
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