Important Factors in the Healing of a Pressure Ulcer in the Ischium of a Spinal Cord-Injury Patient Whose Pressure Ulcers Recurred Over 26 Years

Objectives:  Pressure ulcers in the ischium of spinal cord-injury patients are caused by their wheelchair-bound lifestyle. Such injuries are intractable and limit a patient's activities of daily life for long periods. Here, we report our experience with a patient whose pressure ulcer was healed without limitation of her daily activities. Subject:  A woman aged 56, who had injured her thoracic spinal cord 26 years earlier, developed a pressure ulcer in the right ischium. The injury healed and then recurred over 10 admissions for treatment, and the maximum period over which the patient stayed at home without a pressure ulcer was only two months over the past several decades. In June 2002, she was healed and discharged, but the pressure ulcer recurred in the same region only one month later. Course:  She was treated in the outpatient department, but the affected area expanded and the condition aggravated and invaded the subcutaneous tissue. The causes were considered to be a body posture leaning to the right, rubbing during decompression, and pressure on the lesion exerted by a cushion of the wheelchair. Treatment of the patient began from a consideration of daily activities, including work and housekeeping. The cushion was changed to a new one that helped the patient maintain a good posture and prevented rubbing. In addition, the patient was instructed to develop a decompressing action that dispersed the body pressure to the posterior thigh, and was shown how to sit during monthly visits to the outpatient department. The affected lesion was washed every day in the shower, and was treated with sugar and povidone-iodine. Results:  The patient observed changes in the affected lesion of the pressure ulcer, and reported changes that occurred in her daily life. In April 2003, the pressure ulcer had healed and has yet to recur 8 months later. Conclusions:  (1) For pressure ulcers in the ischium of a spinal cord-injury patient, it is of importance for healing and prevention of recurrence to find the cause of the pressure and to improve the condition, rather than to treat the affected lesion. (2) Instructions regarding adoption of the correct sitting position, i.e., a major factor in daily life, and continuous care intervention improved the patient's self-care ability.