inner thigh pressure ulcer stage 3

86y/o female who presents with a right inner thigh stage 3 pressure ulcer x 1 year. Patient is wheelchair bound. Prior treatment include weekly debridement and Santyl, Prisma, Xeroform, Mepilex. We then tried tissue product and 3M wound vac. Wound vac failed d/t pain and poor tolerance. Currently wound is measuring 2.5cm x 2.9cm x 1.3cm. There is undermining throughout. No tunneling. Wound is not getting better nor is it getting worse. We tried cellular tissue product but her incontinence is making the dressing not suitable for the cellular tissue product. Patient is allergic to iodine dye. Not diabetic. She is being seen three times a week. Please advise.

Jan 9, 2023 by Jeffrey Chinison,

1 replies

Elaine Horibe Song
MD, PhD, MBA

Hi Jeffrey

Thanks for your message. Cathy Milne, APRN and I just talked about this case. Some thoughts to consider:
- Offloading strategy: what was the underlying cause of the PU/PI on the inner thigh? Has it been successfully addressed/offloaded?
- Bioburden management: has a culture been obtained? Are there opportunities to improve cleansing, and try other antimicrobial dressings?
- Are there other factors that might be delaying healing (e.g: incontinence, meds, malnutrition, glycemic control, etc)
A detailed structured approach often helps reassess the patient/ulcer. Please see "PU/PI - Plan Reassessment" at https://woundreference.com/app/topic?id=pressure_ulcer_injury_treatment&find=pressure+ulcer#plan-reassessment

Jan 10, 2023

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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