Background: Pressure ulcers (PU) are common in the spinal cord injury (SCI) population. This review aims to identify the prevalence, risk factors and management of PU in patients with SCI.
Methods: Medline, Embase and CINAHL were screened for relevant articles from 2000 to 2022 using “pressure ulcer” and “spinal cord injury”. This main search was combined with other MeSH terms related to medical and surgical management, antibiotic therapy, diagnostic imaging and histopathology.
Results: A total of 871 articles were identified of which 233 duplicates were removed. Articles were screened for relevance by title and abstract, resulting in a total of 48 included.
Discussion: Approximately one in three spinal cord injury (SCI) patients will have a PU and the lifetime risk is estimated as high as 85%. Completeness of spinal injury is a significant risk factor. There is a lack of consensus about demographic factors and medical comorbidities in PU prevalence. Medical management for stage I and II PU includes cleaning, wound debridement and dressings. Osteomyelitis is common and should be diagnosed with intraoperative bone biopsy. Stage III and IV PU require staged reconstruction. Complication and recurrence rates are high with malnutrition identified as the most significant risk factor. Negative pressure wound therapy, hyperbaric oxygen and fat grafting have limited evidence in the SCI population.
Conclusion: PU causes significant morbidities in SCI patients. Patients should be medically optimised prior to definitive treatment. This narrative review provides the background information for us to compare our practice and outcomes on the management of PU in SCI at the Victorian Spinal Cord Service at the Austin Hospital, Melbourne, Australia.