Utilisation of skin blood flow as a precursor for pressure injury development in persons with acute spinal cord injury: A proof of concept.

People with spinal cord injury (SCI) are at high risk of developing a pressure injury. It is unclear why some people with SCI develop pressure injury while others with similar predisposing risk factors do not during acute hospitalisation. This may hinder healthcare utilisation to prevent pressure injuries. The purpose of the study was to examine the proof-of-concept objective bedside skin blood flow measurements before a pressure injury develops in spinal cord injured patients during acute hospitalisation. This was an observational study. All participants had acute traumatic SCI and were pressure injury-free upon enrollment. Skin blood flow patterns were collected at both heels under two circumstances: localised pressure for reactive hyperemia, and localised heating for heat hyperemia. Our results showed that reactive and heat hyperemia were successfully induced in all eleven participants. Two participants developed pressure injury and nine did not have pressure injury at discharge. Heat hyperemia was smaller in participants with pressure injury. No difference was observed in reactive hyperemia between the groups. In conclusion, skin blood flow measurements could be obtained at bedside during acute hospitalisation of SCI for the purpose of research. Further examination of a larger group is warranted to determine clinical use of heat hyperemia pattern as predictor for pressure injury development.

The Role of Hyperbaric Oxygen Therapy for the Treatment of Wounds.

Hyperbaric oxygen (HBO) is a Medicare-approved treatment for a variety of diagnoses including chronic nonhealing wounds and radiation necrosis. Hyperbaric oxygen therapy (HBOT) uses high pressures to saturate hemoglobin and dissolve oxygen into blood plasma to create a hyperoxemic environment to nourish and reverse local tissue injury caused by ischemia and hypoxemia. HBOT is expensive and not without risk; therefore, the underlying etiology for the presenting diagnosis must be adequately treated before starting HBO as an adjunct therapy to get maximum benefit.

Anterior spinal cord syndrome of unknown etiology.

A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome.