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Management of Pressure Ulcers
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To the Editor: In his discussion of the physical examination of pressure ulcers, Dr Lyder1 did not discuss palpation of pulses and assessment of circulation. Often the first sign of globally insufficient circulation to a foot is the loss of ability of the tissue to repair following minor trauma.2 The main factor behind this inability to repair is macroscopic vascular occlusive disease, meaning occlusion of large arteries, rather than microvascular disease. Although diabetes mellitus is the most common risk factor because of tibial artery atherosclerosis, a similar mechanism can lead to tissue loss in the presence of connective tissue disorders.2 Debridement of necrotic tissue is indicated for pressure sores, except when ischemia is manifested. An ischemic extremity must be revascularized to restore its ability to heal.
Jeffrey L. Kaufman, MD
Vascular Services of Western New England
Springfield, Mass
1. Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289:223-226.
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2. Kempczinski RF. The chronically ischemic: an overview. In: Rutherford RB, ed. Vascular Surgery. 5th ed. Philadelphia, Pa: WB Saunders Co; 2000:917-927.
Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;289:2210.
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