0:04
The patient
you're seeing on the slide
is the poster child for the
concept of deep tissue injury.
This is a patient who was
admitted to the hospital
for an elective
laparoscopic cholecystectomy
and was left on a bedpan for
no one really knows how long.
But obviously, the deep tissue
injury occurred at that time,
because you could see
the remnant, if you will,
the imprint, of the bedpan
up on the upper buttocks
on the left-hand side of the screen.
This patient died of this wound.
It became completely
necrotic, and she
required diverting colostomy,
multiple debridements,
and died of sepsis from the wound.
So what she taught us was that
this problem that we today call
deep tissue injury is actually
a very serious problem
and could lead to fatalities
in pressure ulcers.
0:56
The idea of deep tissue
injury was studied
by the National Pressure
Ulcer Advisory Panel.
Myself and Richard Bennett were
the original two investigators.
And we decided to look at the
history of deep tissue injury.
And so we went back as far
as Dr. Paget's work in 1874.
And we found something interesting.
We found that, even back in 1874,
he described a skin problem that
was purple when it first showed up.
And purple was not in the original
definition of pressure ulcers.
As you well know, it talked
about non-blanchable erythema.
But Dr. Paget saw purple skin.
And he also said that
the deeper tissue
dies, the muscle and the bone.
And when it sloughs, the
place behind is empty.
So it told us, even
back as far as 1874,
that there was another
phenomenon around.
Dr. Groth, during World War
II, created a pressure ulcer
with a pressure plate and muscle.
And due to the rate
of deterioration,
he said they were
malignant by nature.
Dr. Shea talked about
closed pressure ulcers.
They were never described
in the staging systems
that came into play
in the later 1970s.
And of course, we had a
lot of clinical records
to look at in which people
were calling these wounds
"purple" pressure ulcers or
bruises over intact skin.
Some people thought they were
cautery burns when they saw
them coming out of
the operating room.
But in all instances, they evolved
into full-thickness ulcers.
