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they mention two cases of cauda equina lesion from the First World War. Although this
complication is a rare one in chronic sores, we have, amongst our material of several
thousands of sores, one single incident of an epithelioma developing in the scar of a
healed sacral sore (Fig. 205) which was excised by Dr Walsh and did not recur.
Complications following pressure sores
A. Infection: osteomyelitis, septicaemia
Sores always become infected, and, as already mentioned, in paraplegics they are, like
the urinary infection, the commonest cause of sepsis and death. The infection is as a rule
a mixed one of
Staph. aureus, B. strep, haemolyticus, Proteus., B. coli,
and
Ps. pyocyanea,
and will, if not counteracted from the very beginning, involve the deeper tissues and
extend to the bone, causing periosteitis, osteitis, and osteomyelitis, with necrosis on the
one hand and heterotopic bone formation on the other. Fig. 206 demonstrates two ischial
FIG. 206. Ischial sores with underlying osteomyelitis and ectopic calcification.
