Key Points
Introduction
The early detection of suspected pressure injuries in individuals with SCI may be improved through the use of a handheld dermal phase meter and ultrasonography.
Magnetic resonance imaging may be helpful to anticipate the development of osteomyelitis secondary to non-healing SCI-related pressure injuries.
Circulatory biomarkers in people with SCI have not yet proven to be useful or feasible to enhance early detection of suspected pressure injuries.
Prevention
Electrical stimulation has potential to reduce IT pressures by activating muscles, increasing blood flow and tissue oxygenation to stimulated area, all of which likely helps to prevent pressure injury formation or progression.
Fat grafting may have potential as a prevention strategy for those people where other strategies have not been successful; ongoing pressure management strategies are still required post grafting.
Pressure mapping studies using non-disabled people should not be generalized to the SCI population because pressure differences exist between the two groups. Data generated from pressure mapping studies on seniors should not be generalized to the SCI population because differences exist between the two populations.
Early attendance at specialized seating assessment clinics should be part of a comprehensive rehabilitation program. More research is needed to determine if early attendance at a specialized seating assessment clinic (SSA) results in pressure injury prevention over time.
Structured pressure injury prevention education, helps individuals post-SCI gain and retain knowledge of pressure injury prevention practices, but it is questioned if the same strategies are effective for those with chronic and/or severe pressure injuries. More research is needed to determine the best approaches of pressure injury prevention intervention to reduce pressure injuries post-SCI, particularly for chronic and/or severe pressure injuries, to assist with lifestyle and behaviour changes for long term pressure management success.
The role of telerehabilitation in engaging individuals with SCI with prevention education and treatment programs has demonstrated potential but to be fully successful, requires a compliment between program content, delivery format and accessibility to that format for all people with an SCI regardless of living situations.
Products and surfaces used for prevention should be combined with other preventative measures/strategies to optimize the potential to reduce risk of pressure injury development.
Treatment
Electrical stimulation added to standard wound management promotes healing of Stage III and IV pressure injuries post SCI. More research is needed to determine optimum electric current and application protocols to improve healing of pressure injuries post SCI.
Laser treatment does not improve pressure injury healing post-SCI. US/UVC should be considered as an adjunct treatment when pressure injuries are not healing with standard wound care post-SCI. Pulsed electromagnetic energy improves wound healing in Stage II and Stage III pressure injuries post-SCI.
Wound healing is improved with intermittent negative pressure (INP) devices in combination with standard wound care (SWC) for at-home care of pressure injuries compared to SWC alone.
Negative pressure wound therapy (NPWT) has shown to reduce levels of MMP-8, increase the rate of healing, reduce exudate production and enhance the rate of formation of red granulation tissue when compared to conventional wet gauze alone.
Pressure injury healing after an SCI is improved when topical negative pressure (TNP) therapy is administered as compared to traditional sodium hypochlorite dressing changes.
VAC therapy may be quite a versatile device but has some disadvantages. Only qualified medical/paramedical personnel should use it in order to avoid possible complications that can occur after an improper application. Normothermic dressings may improve healing of pressure injuries post-SCI.
Recombinant human erythropoietin shows promise in assisting with the healing of stage IV chronic non-healing pressure injuries post-SCI.
Platelet-rich plasma therapy may be a promising alternative to standard saline dressing for pressure injury healing, however additional study is required to validate PRP therapy as a possible treatment for severe, non-healing pressure injuries in people with SCI. Local application of PRP may reduce bacterial presence and colonization in PIs. The anabolic steroid agent Oxandrolone does not promote healing of serious pressure injuries post-SCI.
Occlusive hydrocolloid dressings are useful for healing of stage I and II pressure injuries post-SCI. Platelet gel dressings used within the first two weeks of treatment will trigger pressure injury healing post-SCI.
Pulsatile lavage therapy is an effective, and likely safe, non-surgical management and debridement method for the treatment of grade III and IV pressure injuries secondary to SCI.
Maggot therapy is also likely useful in this patient group.
Silicone moulding may also be considered as a radical en bloc debridement method for grade IV pressure injuries in people with SCI.
Use of topical oxygen therapy may have a positive association with healing of pressure injuries post SCI but more research is needed.
Proximal amputations of the lower limbs, in properly selected patients, can reduce the number of hospital stays, and improve the quality of life and functional outcome.
People with spinal cord injury with persistent grade III and IV pressure injuries in the thigh and buttock region may benefit from surgical reconstruction.
Medihoney® may be useful to treat persistent stage III and IV pressure injuries in individuals with SCI.
CRFSO may be superior to ARO to promote accelerated healing of pressure injuries in people with SCI.
Arginine supplementation in individuals with SCI may be helpful in accelerating pressure injury healing.
Pressure point localized cooling is not an effective pressure injury prevention strategy for people with SCI.
The use and implementation of clinical practice guidelines may help individuals stop smoking.
Many factors play a role in the development, course, and treatment of PIs. It is vital to understand the role of patient risk factors in the development of PIs, to direct subsequent management and reconstruction, and to prevent future recurrences.
