Abstract
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Introduction: Pressure Injuries (PIs) are serious events impacting the morbidity and mortality of individuals with severely limited mobility, notably wheelchair users with high level or complete spinal cord injuries. The sacral region is prone to these chronic wounds due to direct body weight over bony prominences combined with pressure and shear forces. Recurrence disrupts quality of life and mental health. Addressing recurrent PIs requires a comprehensive care pathway including analyzing the microclimate, managing mechanical loads, providing metabolic support, and empowering the individual to self-manage risk.
Objective: To report on a specialized enterostomal therapy intervention focused on the management and tissue stabilization of a wheelchair user experiencing recurrent sacral PIs.
Method: This descriptive experience report is based on home-based clinical practice in enterostomal therapy involving a 54-year-old male patient with diabetes and a traumatic spinal cord injury (T12 paraplegia) sustained two years prior. As a wheelchair user, he experienced recurring PIs in the sacral region, with a history of three recurrences within 18 months, the most recent being a stage 3 pi. The therapeutic plan and data collection were guided by the nursing care process, the TIMERS framework, biomechanical positional analysis, assessment of the microclimate and support surfaces, and three-dimensional wound measurement over a two-month period with weekly visits. Ethical standards were upheld in accordance with CNS resolution no. 466/2012, with informed consent (TCLE) and guaranteed anonymity.
Experience report: The specialized clinical approach focused on two primary factors contributing to Pressure Ulcer (PU) recurrence: 1) Mechanical fragility of newly formed tissue (type iii collagen predominance over type I, resulting in 80% of original tensile strength); and 2) Hidden factors: Microclimate, biomechanics, and support surfaces (cushion "bottoming out," heat/moisture from diapers, and shear forces during transfers). The therapeutic plan included nursing guidance structured around: A) Biomechanical optimization: Safe transfer training using a transfer board; replacing cushions with high-tech, interconnected air-cell systems providing hydrostatic flotation (recalibrated weekly with a portable pressure gauge); performing "push-up" maneuvers or trunk-lifting exercises every 20–30 minutes; and daily skin inspection using a mirror. B) Metabolic support and glycemic control: A diet rich in protein, collagen, vitamins (a, c, e), and zinc; reduced sugar intake; consistent water consumption; and immunomodulatory supplements enriched with arginine. C) Skin integrity repair and maintenance: Silver-impregnated hydrofiber dressings combined with silicone bordered polyurethane foams; alcohol-free protective films on surrounding skin; and moisture management through scheduled catheterization. D) Emotional support: Managing anxiety related to bed rest and temporary loss of autonomy. Transitioning to a multidimensional approach breaks the cycle of recurrence. Following the healing of the most recent lesion, the patient remained free of new pressure ulcers for 10 months, demonstrating improved quality of life.
Final considerations: Sacral lesion recurrence in wheelchair users involves complex factors, rendering passive dressings insufficient. Prevention requires combining advanced, technology-based dressings with active modifications to the daily routine, empowering the individual to actively protect their own skin.
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