Résumé
Surgical indication is recommended for specific locations (pelvic stage 3 and 4 pressure ulcers) and if medical treatment is impossible:
– global patient assessment is recommended before surgical indication with benefits and risks analysis;
– analysis is conducted on several stages;
– risk factors analysis and control level;
– efficiency analysis about medical and preventive coverage;
– pressure ulcer origin analysis;
– compliance patient assessment (care contract);
– systematic pre operative procedure is recommended:
– multi-disciplinary et pluriprofessionnal consultation;
– psychological assessment and follow up;
– radiological assessment (systematical, no systematical IRM except if osteitis, no TDM, no scintigraphy);
– biological assessment (inflammatory nutritional, micro biological);
– no pre-operative antibiotherapy;
– specify definition of surgical type
– realize pre-operative micro biological taking is recommended:(according to bone aspect):
– enforce systematic post operative procedures is recommended:
– plan patient installation: every patient must have a preventive mattress and book curative mattress for multiple scrap;
– plan total immediate post operative dumped according to patient compliance in PRM ward (during at least 3 weeks, often 4);
– organize seated station progressive recharging in PRM ward (during at least 3 weeks);
– extend patient supervision and allow seated station;
– plan further supervision.