Letters to the Editor: Unusual Pressure Ulcer of the Arm Due to Cuff of Sphygmomanometer

Dear Editor:   Pressure ulcer formation is a complex process. Many environmental and systemic factors contribute to their development, with excessive and prolonged pressure being the most important factor.^1,2   Pressure that exceeds the end-capillary bed pressure impairs tissue perfusion, and prolonged pressure deprives tissues of oxygen and essential nutrients, leading to ischemia and subsequent ulceration.²   Pressure ulcers mostly occur on the areas of skin overlying bony prominences.² Here, we report an unusual pressure ulcer of the left arm caused by the cuff of a sphygmomanometer.   A 46-year old male patient presented to our clinic with a necrotic ulcer 5 cm x 6 cm in size on the medial side of his left arm (Figure 1). He was admitted to the emergency department of the hospital with acute gastrointestinal bleeding 1 month prior, and subsequently admitted to the intensive care unit after a truncal vagotomy and pyloroplasty with a wedge resection of the ulcer.   The patient’s blood pressure was monitored by sphygmomanometer in the intensive care unit. Despite intermittently inflating and deflating during periods of monitoring, a pressure ulcer developed where the cuff of the sphygmomanometer was applied because the cuff remained continously attached to the left arm.   All of the necrotic and endurated areas were debrided under general anesthesia. Following debridement, the defect was repaired with a lateral arm island flap. The flap was adapted to the recipient site through a subcutaneous tunnel, and a full-thickness skin graft was applied to the flap donor site. There was no problem after 18 months follow-up (Figure 2).   The presented case represents an unusual example of pressure ulcer location. Staff members of intensive care units must be aware of the potential development of this kind of pressure ulcer. If they have applied the cuff of a sphygmomanometer for arterial pressure monitoring, they must be mindful of changing the arm to which the cuff is applied to avoid pressure ulcer development.   Sincerely,   Kemalettin Yildiz, MD   Bezmialem Vakif University   Istanbul, Turkey

References

1. Janis JE, Kenkel JM. (2003). Pressure sores. Selected Readings Plast Surg. 2003;9(39):1-42. 2. Foster RD. Pressure sores. In: Mathes SJ, ed. Plastic Surgery. 2nd ed. Philadelphia: Saunders-Elsevier; 2006:1317-1353.