F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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this septic condition has on the nitrogen balance of the patient. The drainage from sores
results in continuous loss of protein. Poer (1946) found a daily loss of as much as 50 g of
body protein as a result of drainage from sores. In fact, we have admitted paraplegics
with pressure sores in such an extreme state of malnutrition that it could be compared
only with that of inmates of Belsen Camp (Belsen type of paraplegic) (Figs. 6 and 7).
Treatment
General.
In analysing the problem of treatment of pressure sores in paraplegics, it must
at once be emphasized that local treatment of sores, whatever the method, will be of little
or no avail unless it is correlated from the outset and throughout all stages of treatment,
with the achievement of the best possible general condition. The importance of combating
nutritional deficiency, the maintenance of nitrogen balance, and the treatment of anaemia,
as some of the most important factors determining the rate of healing, cannot be stressed
too much. In most of these cases with sores, repeated blood transfusions have to be
given, and these, apart from high protein diets and vitamins, have proved to be the most
efficacious way of dealing with anaemia and nutritional deficiency in these cases. It is
necessary, in certain cases, to give at least one pint of full blood or, if undesirable reactions
occur, packed red cells in saline at least once a week. There was one patient who came in
with 17 sores who had as many as 81 blood transfusions during one year. All sores were
healed and the patient discharged to his home. Cooper
et al.
(1950, 1951) claimed that
testosterone improves the nitrogen balance because of its anabolic properties, and that
this results in gaining weight and decreases the incidence of pressure sores in paraplegics.
This has not been confirmed by other workers. Menion & Sheba (1961), using norethan-
drolone (Nilevar) in a double-blind trial on 395 geriatric patients, found no value in this
drug for the prevention of pressure sores.
Local
(a) Prophylaxis.
In discussing some of the main aspects of treatment mention must be
made first of prophylactic measures. If the slogan 'Prevention is better than cure' has
ever had any meaning, then it is in connection with pressure sores in paraplegics. Preven
tive measures should start immediately a paraplegia has occurred following injury, by
removing hard objects from the patient's pockets, furthermore by padding bony promi
nences, counteracting traumatic shock, and, most important of all, by immediate trans
portation of the patient preferably to a spinal unit or hospital which can deal with spinal
injuries. The immediate or very early admission of spinal cord injuries to a spinal unit has
the great advantage that the whole set-up of such a unit, with its specialized medical and
nursing staff, provides the best guarantee for the prevention of sores which, once deve
loped, greatly delay the paraplegic's discharge from hospital and his rehabilitation to a
useful life.
The cardinal prophylaxis is frequent change of posture, at least every 2 hr day and
night, to relieve and redistribute pressure. The bony prominences over sacrum and
