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The use of Epi-Lock dressings was compared to moist saline dressings as a treatment for Stage II and III pressure ulcers in 38 patients. Demographic and clinical data were collected at the onset of the investigation. At the time of enrollment and during weeks six, 12 and 24, pressure ulcers were inspected and measured, and laboratory data were collected. More healing occurred with Epi-Lock dressing than with moist saline dressing for Stage II and III pressure ulcers. Although individual Epi-Lock dressings were more expensive than saline dressings, they required less dressing changes. Therefore considering cost of nursing time, Epi-Lock dressings are more cost effective.

Although the physiological effects of pressure on tissue have been demonstrated in the animal model, little is known about its effect in ill, elderly patients who are at risk for pressure ulcers. This study describes the pattern of dermal blood flow during a period of constant, low-level, compressive pressure in this population of patients. Dermal blood flow was measured over the trochanter of 16 elderly (> 60 years) subjects who were defined as at risk for pressure ulcer development by the Braden Scale for Predicting Pressure Ulcer Risk. Using a laser-Doppler velocitometer, blood flow at baseline and during 60 minutes of left-side lying on an air mattress were measured. Mean blood flow at baseline was 0.79 (SD 0.43). Following 60 minutes of compressive pressure, mean blood flow was 0.65 (SD 0.87). Blood flow tracings during the 60-minute period of continuous, compressive pressure revealed an inconsistent pattern of response; the flow increased, decreased, or showed no change. This distribution of responses suggests that significantly more variability in blood flow response exist in at-risk individuals than was previously believed.

The objective of this study was to evaluate and compare various methodologies of measuring the characteristics of pressure ulcers. This prospective, four-week, follow-up study consisted of 20 patients, of whom 17 completed the study. Each patient had at least one full-thickness pressure ulcer (surface area between 1.2 and 61.6 cm2) that had been present for at least four weeks. The ulcers were assessed weekly for four weeks using the following techniques: direct measurement (length, width, and depth), tracing of the ulcer outline onto transparent material, standard photography, and volume measurement. Computer-assisted planimetry from the tracings and photographs, and calculations from the direct measurements determined ulcer areas. Each technique estimating ulcer area gave similar results; however, the areas obtained from the direct measurements slightly over-estimated the areas when compared with the areas obtained by computer-assisted planimetry (mean difference of about 1.5 cm2). Areas obtained from the photographs were more variable than the other measurement techniques. Volumes calculated from bedside measurements were consistently larger than those calculated by jeltrate impression (mean difference of 4.0 cm3). While all the measurement methodologies gave similar and reproducible results, the areas obtained from the photographs were more variable than the areas obtained from the other measurement techniques. The photographic measurements could be improved either by tracing the ulcer outline at the bedside onto the photograph shortly after being taken, or by drawing an outline of the ulcer margin directly on the patient's skin just before taking the photograph.

Challenged by annual expenditures exceeding $5.9 million dollars for specialty support surface rentals, the National Center for Cost Containment (NCCC), an office of the Department of Veterans Affairs (VA), organized a Technical Advisory Group (TAG) to identify strategies for the appropriate use and cost-containment of specialty support surfaces. A survey of utilization patterns revealed that some VA facilities (n = 20) had no expenditures for rental of specialty support surfaces while others (n = 13) spent over $100,000 per facility on rental expenditures. Many facilities had a significant cost savings by owning specialty support surfaces. A decision-making tree, emphasizing first line devices, was developed to assist in containing expenditures. It was recommended that this algorithm be used in conjunction with the Specialty Support Surface Guidelines developed by the TAG. It is anticipated that this information may assist both VA and non-VA healthcare facilities to contain costs in the utilization of specialty support surfaces.