The management of pressure sores by constant-tension approximation

The management of pressure sores in medically compromised patients is problematic as they are seldom candidates for major surgical procedures. We treated 52 pressure sores in 49 patients (including three bilateral lesions) by constant-tension approximation. The lesions were distributed as follows: 21 sacral, two ischial, 13 trochanteric and 16 posterior heel. The average age was 75 years and there were 22 males and 27 females. All patients had significant co-morbid conditions that, except for one wheelchair-bound person,confined them to bed. Nine patients were insensate; in two comatose cases this state was temporary. The management regime consisted of excision of the pressure sore and expansion of the skin and subcutaneous tissue using devices that, by means of continuous low-grade tension, approximated the wound edges, together with rigorous wound toilet and the judicious use of sutures. In total, 38 pressure sores healed primarily without recurrence, including three wounds that partially reopened and healed; 11 of these patients died, with healed wounds, at varying times between 2 and 48 months after treatment. Nine patients whose lesions were closed died within a month of treatment, and five patients, three of whose lesions were completely closed and two partially closed, were lost to follow-up; their lesions were not regarded as healed. This minimally invasive technique used to close pressure sores in elderly patients with co-morbid conditions has a satisfactory success rate.