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Overview :
Okamoto et al identified risk factors for skin breakdown in
patients with myelomeningocele. Compensating for these problems can reduce the
risk of pressure ulceration. The authors are from the University of Washington
and Children's Orthopedic Hospital in Seattle, Washington.
Skin injury is common in patients with myelomeningocele and
may include:
(1) dermatitis
(2) abrasions
(3) lacerations
(4) decubiti
Risk factors for skin breakdown:
(1) incontinence-associated dermatitis (stool and/or urine)
(2) excessive pressure, including asymmetrical
weight-bearing
(3) excessive shear forces, including excessive motor
activity
(4) mental retardation
(5) large head size (? hydrocephalus)
(6) kyphoscoliosis or kyphosis
(7) rubbing or pressure from an orthotic device or plaster
cast
(8) high paraplegia
(9) skin anesthesia (high sensory impairment)
(10) joint deformity
(11) abnormal neurologic examination of the upper
extremities
(12) poor compliance by family with management instructions
The risk of skin breakdown can be reduced by:
(1) educating the patient and family
(2) proper fitting of orthoses, casts and shoes
(3) frequent exams, with prompt attention to any skin
problem
(4) management of incontinence
(5) pressure reliefs
(6) symmetrical weight-bearing
(7) identification and removal of factors causing skin
damage
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