Table 1 The “Basel Decubitus Approach” structured to focus, profession and content
Focus | Profession | Content |
|---|---|---|
Classification of PI | Paraplegiologist Plastic Surgeon Nurse | Classification of PI according to definition of the EPUAP and NPUAP (reference). Documentation following international recommendations (reference) including photos |
Pressure relief | Paraplegiologist Plastic Surgeon Nurse | Immediate immobilization after admission for inpatient treatment either on airflow mattresses or with supine ventral positioning, if possible. |
Local dressing | Paraplegiologist Plastic Surgeon Nurse | Application of dressing according to the TIME concept. Removal of necroses, treatment of infection (local disinfection and/ or surgical debridement) and negative pressure therapy or three times per day wet dressings. |
Diagnostic and treatment of risk factors | Paraplegiologist | Standard blood analyses: inflammation, anaemia, electrolytes, kidney and liver function and nutrition profile |
Dietitician | The SNST (Spinal Cord Nutrition Tool) is administered to detect nutrition and nutrition. Counselling is added to address the special needs during the treatment of the PI and respect the changed protein and caloric requirements | |
Paraplegiologist | Screening of neurological changes and examination of the international standard for neurological classification in SCI. | |
Paraplegiologist Nurse Physical therapy | Examination of pulmonary function. Breathing therapy and exercise. | |
Paraplegiologist Physical therapy Occupational therapy | Examination of the lower extremities (range of motion) and of the spine (scoliosis?) and evaluation of the seating position. | |
Psychologist | Screening of psychological risk factors and integrated psychotherapy by individual indication. | |
Flap surgery | Plastic surgeon | Closure of PI with fasciocutaneous tissue if possible: os ischium – posterior thigh flap, os sacrum/ coccygis – gluteal rotation flap, os trochanter – lateral thigh flap/tensor fasciae latae flap. |
Diagnosis and therapy of osteomyeliltis | Plastic surgeon Paraplegiologist Infectiologist | Bone biopsies during the surgical debridement or flap surgery. Bacterial diagnostic and empirical and targeted infection treatment with antibiotics about 6 weeks if osteomyelitis. |
Postsurgical immobilisation | Plastic surgeon Paraplegiologist | According to the diagnosis of osteomyelitis and recurrence the postsurgical bed rest is 4 or 6 weeks. |
Prevention of secondary complication or recurrence | Interdisciplinary and interprofessional team | Individual risk analyses Evaluation of seating position and cushion Evaluation of transfer techniques and strengthening of the upper extremity |