Nutritional and Biochemical Insights into multiple Pressure Ulcer Management: A case report

Alica Hokynková ^1,2 Hana Paulová ^2* Petr Šín ^1,2 Marie Novakova ² Petr Babula ² Andrea Pokorná ²

• ¹ University Hospital Brno, Brno, Czechia
• ² Faculty of Medicine, Masaryk University, Brno, South Moravia, Czechia

This case report presents a unique study focused on relationship between nutritional parameters, C-reactive protein (CRP), and the marker of oxidative stress which is 8-hydroxy-2´-deoxyguanosine (8-OHdG), in 61-year-old male paraplegic patient paraplegic patient with multiple pressure ulcers. where theA multidisciplinary approach was essential for the timing of the successful reconstruction process.The patient had a history of paraplegia since 1999 due to a skiing accident with fractures of thoracic vertebrae (Th6-Th9), requiring spinal surgery. His medical background includes acute pancreatitis with biliary tract revisions, partial pancreatic resection, acute respiratory failure with tracheostomy, renal failure treated with hemodialysis, bronchopneumonia, pseudomembranous colitis, and hyperuricemia. The patient also underwent multiple surgical interventions, including treatment for ulnar nerve paresis, cholecystectomy, and multiple pressure ulcer reconstructions. ItThe study describes the relationship between selected biochemical parameters and overall clinical status in a paraplegic patient with three deep pressure ulcers located in the left-sided ischial, trochanteric, and sacral regionsthree pressure ulcers during their multistage surgical therapy. The reconstructive procedure and collection of biological samples for determination of selected biochemical paramete rs were performed according to the same schedule: debridement of pressure ulcers at the beginning of the particular hospitalization and at on the day of surgicalery reconstruction . The patient's severe condition was accompanied by decreased levels of both 8-OHdG and selected nutritional parameters (albumin, prealbumin, and total protein) and increased CRP levels at the beginning of the treatment process. The evaluation of the dynamics of the measured parameters during the gradual improvement of the patient´s condition and the multistage reconstruction of pressure ulcers in six hospitalizations over a period of 17 months was continued resulting in the healing up of all pressure ulcers. This case emphasizes highlights the crucial importance of investigationg of selected biochemical parameters, with emphasis on 8-OHdG, and nutritional parameters, for the timing of surgical strategy timing and complex comprehensive therapy in of multiple pressure ulcers in patients with multiple pressure ulcers and severe, complex medical historyies.