If the patient's skin care habits permitted his original skin to break down, flaps have little to no chance without a change in behavior. Once the physiatrist or primary care physician is convinced that the patient is better able to care for his skin, ulcer closure, usually with flap tissue, is indicated. If the patient or his support system cannot be educated in skin care, then closure of the ulcer is not possible, and open wound care must be provided for the remainder of the patient's life. Care of deep ulcers at the University of Washington is provided on the Rehabilitation Service, as for other problems related to spinal cord injury. The first step is evaluation by the physiatrist.
Preoperative care includes sharp debridement, hydrotherapy, and wet to dry dressing changes.
Actual osteomyelitis is not common, so a workup for this diagnosis is rarely indicated. Spasms must be relieved with oral Dantrium, Valium or baclofen, or intrathecal baclofen, or with surgery. Bladder infections are controlled. Bowel control is achieved, although enemas are not used, since they may produce intraoperative evacuation. The postoperative immobilization plan is made and rehearsed.