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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
Pressure Ulcer or decubitus Ronald H. Houwing Throughout his medical studies, Ronald Houwing (1958) had been intrigued by pressure ulcers, or bedsores. Besides his interest in the pathophysiological mechanisms of this disease, he was taken by the lack of interest in this subject by docters, an unglamorous aspect of healthcare though it is. During his training as a dermatologist in Utrecht under Willem A. van Vloten, he joined the “hospital pressure ulcer team”. At the final stage of his specialisation he had the opportunity to start an animal study of the pathophysiology of pressure ulcers. This study showed the role of oxidative stress in the pathophysiology of pressure ulcers and, further, a reducing tissue-damaging effect of the oxidant vitamin-E.[1,2] He started working as a dermatologist at the hospital of Deventer in 1991 and continued there with research in the field of pressure ulcer prevention. Contrary to the positive results found in his animal research, one human study revealed that there was no significant preventive effect by adding nutritional supplements enriched with antioxidants.[3] A study with a locally applied antioxidant (DMSO) in people at risk of pressure ulcers, even showed a detrimental effect.[4-6] More studies are necessary to establish the safety and effectiveness of antioxidant therapy. Risk assessment tools are used to identify a person in danger of developing pressure ulcers. However, these tools have proved inadequate to determine this risk and therefore they should not be used as the only diagnostic instrument.[7] There again, a skin assessment is an indispensable method of recognising individuals at risk of developing pressure ulcers. Insight into the pathophysiology of superficial pressure ulcers in the incontinent elderly led to the adjustment of international guidelines.[8] While better-designed studies are no doubt necessary to diminish the incidence and burden of pressure ulcers, the attention and care of the nursing staff remains and continues to be an indispensable element. References 1. Haalboom JRE, Asbeck BS van, Jonasse Y, et al. Pressure sores are caused by oxygen free radicals. Eur J Clin Invest. 1991; 21: 58. 2. Houwing RH, Overgoor M, Kon M, Jansen G, et al. Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E. J Wound Care. 2000; 9: 36-40. 160 Decubitus ulcer on the right buttock. BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:41 Pagina 160