Hair braids as a risk factor for occipital pressure ulcer development: a case study

The development of pressure ulcers in acute care settings remains an important concern, especially in high-risk populations such as patients who are critically ill and admitted to an ICU setting. In addition to immobility and other risk factors associated with critical illness, occipital pressure ulcer development has been associated with young age (neonates, infants, and young children) and patient care devices (cervical collars, bed lateral rotation). A 7-year-old boy was admitted to the pediatric intensive care unit with severe sepsis that progressed to multi-organ failure including respiratory distress requiring mechanical ventilation, cardiovascular failure requiring extracorporeal membrane oxygenation, and renal failure requiring dialysis. At 4 weeks, hair braids that were placed before admission were taken down, revealing five full-thickness occipital lesions. All wounds eventually healed, but scarring alopecia at the site of the largest wound was visible. This is the first case study describing hair braids as a potential risk factor for occipital pressure-related skin dam- age and suggests that if a patient is immobile and admitted with braids, patient/family and nursing staff education should include discussing the importance of releasing the hair to decrease the risk of occipital ulcers.