{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T16:50:05Z","timestamp":1776531005525,"version":"3.51.2"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Adv Skin Wound Care"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title>OBJECTIVE<\/jats:title>\n            <jats:p>Patients with stage 4 pelvic pressure injuries that have large, undermined cavities are at high risk for treatment failure and often fall into the category of palliative care. This case series identified five cases where treatment had stalled, and surgical reconstructive options were limited. Jet lavage irrigation in the outpatient setting was assessed as a treatment alternative.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>From an investigational review board study assessing the use of low-pressure jet lavage irrigation in the outpatient setting for chronic wounds, five patients were identified where the wound dimension increased at least 50% resulting from undermined cavities. All were considered high risk with Charlson Comorbidity Index scores of 5 or greater, and their wound healing had stalled with extended treatments of topicals and medicated dressings. A team of physical therapists irrigated these patients\u2019 wounds at the bedside with 3 L of saline 3 to 5 days per week using a special long irrigation tip to reach the depth of the undermined cavity. Digital planimetry was used to assess healing with wound size as the outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>Reduction of the undermined cavities was seen early within the first 3 weeks. No patient developed wound sepsis, and bacterial contamination was determined by use of autofluorescence digital imaging. Undermining resolution occurred in four patients, and one patient with an improving wound died of COVID-19.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p>This simple method offered clear benefits in each patient, but only one patient survived to complete wound healing. Patient and family satisfaction were high regarding the treatment, which created a painless, odor-free wound.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/asw.0000000000000007","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T19:00:09Z","timestamp":1691002809000},"page":"441-446","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Jet Lavage Irrigation Resolves Stage 4 Pelvic Pressure Injury Undermining"],"prefix":"10.1097","volume":"36","author":[{"given":"James B.","family":"Stiehl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"bib1-20250615","first-page":"244","article-title":"Pressure: back to the basics","volume":"45","year":"2012","journal-title":"J Plast Surg"},{"key":"bib2-20250615","first-page":"202110631","article-title":"The panniculus muscle: a missing link the chronicity of heel pressure injuries","volume":"19","year":"2022","journal-title":"J Royal Soc Interface"},{"key":"bib3-20250615","doi-asserted-by":"crossref","first-page":"778","DOI":"10.3390\/diagnostics11050778","article-title":"Interpretation of near-infrared imaging in acute and chronic wound care","volume":"11","year":"2021","journal-title":"Diagnostics"},{"key":"bib4-20250615","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1053\/apmr.2003.50038","article-title":"The etiology of pressure ulcers: skin deep or muscle bound?","volume":"84","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"key":"bib5-20250615","first-page":"492","article-title":"Etiologic factors in pressure sores: an experimental model","volume":"62","year":"1981","journal-title":"Arch Phys Med Rehabil"},{"key":"bib6-20250615","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/00006534-198011000-00008","article-title":"Differential response of skin and muscle in the experimental production of pressure sores","volume":"66","year":"1980","journal-title":"Plastic Reconstr Surg"},{"key":"bib7-20250615","first-page":"23","article-title":"Histopathology of pressure ulcers as a result of sequential computer-controlled pressure sessions in a fuzzy rat model","volume":"7","year":"1994","journal-title":"Adv Wound Care"},{"key":"bib8-20250615","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1152\/japplphysiol.90897.2008","article-title":"Muscle apoptosis is induced in pressure-induced deep tissue injury","volume":"107","year":"2009","journal-title":"J Appl Physiol"},{"key":"bib9-20250615","first-page":"245","article-title":"Myosubcutaneous infarct: deep tissue injury","volume":"20","year":"2007","journal-title":"Adv Skin Wound Care"},{"issue":"11","key":"bib10-20250615","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1038\/nm.2507","article-title":"Ischemia and reperfusion\u2014from mechanism to translation","volume":"17","year":"2011","journal-title":"Nat Med"},{"key":"bib11-20250615","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.bjps.2015.06.004","article-title":"Parallel pocket incision: less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining","volume":"68","year":"2015","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"12","key":"bib12-20250615","first-page":"CD012032","article-title":"Reconstructive surgery for treating pressure ulcers","volume":"12","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"bib13-20250615","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/1534734618779858","article-title":"Pressure ulcers: risk stratification and prognostic factors that promote recurrence after reconstructive surgery","volume":"17","year":"2018","journal-title":"Int J Low Extrem Wounds"},{"key":"bib14-20250615","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1111\/j.1532-5415.1989.tb06918.x","article-title":"Risk factors for pressure sores. 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