szmtag Treatment Principles for Decubitus Ulcers (20.05.2011)
DÄ internationalArchive20/2011Treatment Principles for Decubitus Ulcers

Correspondence

Treatment Principles for Decubitus Ulcers

Dtsch Arztebl Int 2011; 108(20): 354-5. DOI: 10.3238/arztebl.2011.0354c

Rieger, U M

LNSLNS

In our hospital we have an intensive focus on malnutrition especially in the context of patients with decubitus ulcers, in particular geriatric or paralyzed patients. The “six treatment principles” for treating chronic decubitus ulcers (2) described by our working group is based on interdisciplinary, multiprofessional collaboration between conservative and surgical specialties—not least because of the multifactorial etiology of decubitus ulcers—and its main principle is the investigation of the causes and causative treatment of possibly comorbid malnutrition, which has to be dealt with for the decubitus ulcers to be treated successfully. We determine patients’ nutritional status before plastic surgery in the shape of a so called mini-lympho-nutrogram, which includes the values for albumin, transferrin, zinc, vitamin B12, folic acid, and the lymphocyte count (2). On the basis of the experiences gained in our hospital we can highly recommend the use of the nutrogram, as described by Seiler et al (3) in clinical practice because of our therapeutic successes in our specialty. In our hospital we have no experience with either the SGA (Subjective Global Assessment Score) or NRS (Nutritional Risk Score), but we see clear overlaps with our own assessment of a patient’s nutritional status, because the combination of nutrogram and medical history probably results in a comparable assessment. We mostly administer liquid foods and additional foods perioperatively, percutaneous endoscopic gastrostomy (PEG) tubes are used only rarely (for example, in patients having chemotherapy who have developed decubitus ulcers).

In the context of post-bariatric body contouring after massive weight loss, especially after obesity surgery to induce weight loss, these patients—often still classed as overweight—are often subject to substantial malnutrition, which has to be compensated perioperatively before possible surgical interventions in order to avoid complications.

In sum, I can only agree with Löser: nutritional medicine touches on almost all medical specialties and will have to be made an integral part of medical training for students and specialty doctors.

DOI: 10.3238/arztebl.2011.0354c

PD Dr. med. Ulrich Michael Rieger

Univ.-Klink für Plastische, Rekonstruktive & Ästhetische Chirurgie
Medizinische Universität Innsbruck
Innsbruck, Tirol, Österreich
ulrich.rieger@i-med.ac.at

1.
Löser C: Malnutrition in hospital—the clinical and economic implications. Dtsch Arztebl Int 2010; 107(51–52): 911–7. VOLLTEXT
2.
Rieger U, et al.: Six treatment principles of the basle pressure sore concept. Handchir Mikrochir Plast Chir 2007; 39: 206–14. MEDLINE
3.
Seiler WO, Stahelin HB: Search for factors preventing wound
healing. A motivating therapy concept in chronic decubitus ulcers. Krankenpfl J 1999; 37: 317–23. MEDLINE
1.Löser C: Malnutrition in hospital—the clinical and economic implications. Dtsch Arztebl Int 2010; 107(51–52): 911–7. VOLLTEXT
2. Rieger U, et al.: Six treatment principles of the basle pressure sore concept. Handchir Mikrochir Plast Chir 2007; 39: 206–14. MEDLINE
3. Seiler WO, Stahelin HB: Search for factors preventing wound
healing. A motivating therapy concept in chronic decubitus ulcers. Krankenpfl J 1999; 37: 317–23. MEDLINE

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