ANATOMICAL CONCEPTS (UK) LTD
PREVENTION OF HEEL PRESSURE ULCERS Derek Jones PhD, MBA
SUMMARY OF CONTENTS OUR MAIN TOPICS TODAY
Defining Pressure Ulcers Medical Status + Mechanical Factors Where on the Body Do Pressure Ulcers Occur? What are the Cost Implications? Medical Risk Factors? Pressure and Shear - Mechanical Environment Diabetic Foot Disease Pressure Sore Development How Should We Protect the Heel? The PRAFO Range Features
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DEFINING PRESSURE ULCERS
Pressure Ulcers - also sometimes known as pressure sores, bedsores, decubitus ulcers - are commonly seen in situations where persons are "at risk" due to their medical status. Here is a Definition from Clinical Practice Guidelines "Any skin lesion, usually over a bony prominence, caused by unrelieved pressure resulting in damage of the underlying tissue"
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PRESSURE ULCER RISK IS SHAPED BY..
MEDICAL STATUS
Medical status of the patient is such that risk of pressure sores is elevated due to the presence of one or more risk factors
+
MECHANICAL ENVIRONMENT The body is in contact with support surfaces which apply loads to the body tissues. The nature of these loads can elevate the risk of ulceration
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WHERE DO PRESSURE ULCERS OCCUR?
Most pressure ulcer locations are at bony prominences
AREAS AT RISK we will fo cus on the Heels and Malleoli
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COST IMPLICATIONS 412,000 INDIVIDUALS WILL DEVELOP A NEW PRESSURE ULCER ANNUALLY IN THE UK
Total Cost Estimated at £1.4 to £2.1 Billion "The cost of pressure ulcers in the UK" Bennett, G et al Age and Ageing 2004, Vol 33: No.3, 230-235
Focus should be on prevention AS POPULATION AGES THE INCIDENCE OF ULCERATION IS EXPECTED TO INCREASE Anatomical Concepts (UK) Ltd
PRESSURE ULCERS THERE ARE MANY MEDICAL RISK FACTORS
Diabetic Foot Disease - with Neuropathy & Arterial Narowing Any Chronic Condition Requiring Bed Rest Lower Limb Fractures and Mulitsystem Trauma Combinations of Immobility, Dehydration, Immunosupression, Malnutrition Spinal Cord Injury Critical Care Situations - Immobility Significant Obesity or Thinness Degenerative Neurological Disease such as Dementia Cardiovascular compromise History of Previous Ulceration Compromised Nutritional Status Anatomical Concepts (UK) Ltd
GLOBAL BURDEN OF DIABETIC FOOT DISEASE AN AMPUTATION EVERY 30 SECONDS DUE TO DIABETIC FOOT DISEASE MANY OF THESE ARE PREVENTABLE
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HIGH "PRESSURE" IS BAD
"FRICTION & SHEAR" ARE VERY BAD Anatomical Concepts (UK) Ltd
WHAT DOES THAT MEAN? HOW DO PRESSURE AND SHEAR EFFECTS ARISE?
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Let's Imagine AREA
At Risk
Mechanical Shear Inappropriate Equipment, Poor Patient Transfer and Positioning will Elevate the Risk
Pressure Anatomical Concepts (UK) Ltd
PRESSURE ULCER DEVELOPMENT A CHAIN OF EVENTS
EXTERNAL PRESSURE
PRESSURE PERSISTS
Pressure occludes capillary flow. If this persists blood supply to cells is cut off
Cell has not oxygen supply (Ischemia) and as this persists cells die (Necrosis)
NECROSIS
ULCERATION
Necrosis spreads due to poor waste removal from damaged tissue area
Ulceration occurs due to combination of applied pressure and time. Process is accelerated if Shear is present and or elevated tissue temperatures
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High Pressure for a short time or Low Pressure for a longer time can lead to ulceration AREA
Shear Effects even more destructive than pressure
At Risk Pressure related to size of force applied and inverse of the contact area
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Heel exhibits a small contact area over a bony prominence
It's not just a Tissue Surface effect Anatomical Concepts (UK) Ltd
Severe Ulceration - Diabetic Neuropathy
Resolved at 56 Weeks
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Severe Ulceration - Diabetic Neuropathy Refused Amputation Anatomical Concepts (UK) Ltd
Almost healed 156
WEEKS
LATER
Severe Ulceration - Diabetic Neuropathy Refused Amputation Anatomical Concepts (UK) Ltd
THESE EXAMPLES WERE SUCCESSFULLY MANAGED WITH A PRAFO PRESSURE RELIEF ANKLE FOOT ORTHOSIS An Orthosis to provide total relief from pressure at the heels whether the patient is immobile and in bed or ambulent
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ALWAYS REMEMBER
To Deal With the Mechanical Environment (Pressure and Shear) as well as the Medical Risk Factors We can't say ANY amount of pressure will always be safe Anatomical Concepts (UK) Ltd
HOW SHOULD WE PROTECT THE HEEL? WHAT ELSE SHOULD WE THINK OF?
ZERO! PRESSURE
AND
SHEAR
Is the patient at risk of developing a plantarflexion deformity which will delay early mobilisation (ie: Acute Stroke)? Will protected mobility be required? Special needs? ie: Bariatric How are the toes being protected? Are there deformities to be managed? Avoid Friction During Transfers A n aP t oi xmeilcaaslt C| oDnecsei gp nt sa(nUdK T ) eLct d h
PRAFO FAMILY Pressure Relief Ankle Foot Orthosis
650SKG
652SKG
653SKG
The "original" design with Kodel liner
Adjustable Dorsiflexion/Plantarflexion
Valgus/Varus and Dorsiflexion/Plantar Flexion Anatomical Concepts (UK) Ltd
"STANDARD" PRAFO 650SKG Adjustments Dorsiflexion/Plantarflexion Calf Height Foot length Toe Protection Rotation Bar Prevents Internal/External Rotation
650SKG The "original" design with Kodel liner Anatomical Concepts (UK) Ltd
"STANDARD" PRAFO 650SKG
Metal Upright Structure
Maintains foot and ankle positioning whether recumbent or ambulant
Intrinsic Walking Base
Ensures that ambulation can take place whilst maintaining heel protection
Liner Systems
650SKG The "original" design with Kodel liner
Supplied with Kodel liner or Pad and Strap kit giving space for wound dressings Anatomical Concepts (UK) Ltd
PRAFO FAMILY The 652SKG features all the benefits of the PRAFO family with easy adjustment of the dorsiflexion/plantarflexion angle of the posterior upright The 653SKG extends adjustment possibilities even further by including valgus/varus
652SKG
653SKG
Adjustable Dorsiflexion/Plantarflexion
Valgus/Varus and Dorsiflexion/Plantar Flexion Anatomical Concepts (UK) Ltd
PAD & STRAP CONFIGURATION When greater control of the foot and ankle is required during ambulation the Pad & Strap liner can be used
Anatomical Concepts (UK) Ltd
ZERO PRESSURE OR SHEAR Correct fitting ensures no contact between the vulnerable heel and the support surface
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ROTATION BAR The rotation bar prevents any tendancy to internal or external rotation of the limb
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HOW TO FIT A PRAFO Anatomical Concepts (UK) Ltd
BARIATRIC VERSION 752SKT 140 KG WEIGHT LIMIT
See our website for other variations ANATOMICALCONCEPTS.COM
Anatomical Concepts (UK) Ltd
ISSUES TO CONSIDER
MEDICAL Be Aware of the Medical Factors that Influence Risk of Ulceration and Eliminate or Manage These.
MECHANICAL Ideally Eliminate Pressure and Shear at Areas of Risk such as the Heels. This is True for Protection/Prevention as well as for Wound Healing
SCOPE OF REHABILITATION If Early Mobilisation is Intended Then Choose a Device that Maintains Protection During Ambulation Anatomical Concepts (UK) Ltd
ANATOMICAL CONCEPTS
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