A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury

Skin breakdown, including burns and pressure injuries (PrIs), are devastating complications of SCI. Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized.

• 1
  Skin breakdown is often caused by multiple factors and requires PCPs to familiarize themselves with the individual’s overall health, mobility, and social support.
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  The cornerstone for skin breakdown prevention in persons with SCI is education that takes into account the individual’s preferences and life goals.
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  Acute and chronic osteomyelitis may contribute to nonhealing of stage 4 PrIs and has been found in 25%-47% of nonhealing severe PrIs.