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November 9, 1957


JAMA. 1957;165(10):1280. doi:10.1001/jama.1957.02980280054012

THE medical and surgical management of decubitus ulcers is still a challenging problem. These ulcers are usually preventable but once established they are difficult to cure.1 Paraplegics are especially likely to develop these sores. Moisture of the bedclothes next to the skin and prolonged pressure are causative factors in starting these ulcers. The presence of infection makes them hard to heal. It is now recognized that a disturbed metabolic state is necessary for both their formation and their chronicity.2 Specifically, a hemoglobin level of less than 12 Gm. per 100 cc. and an inadequate serum protein level are important factors. Massage or alcohol rub of the devitalized skin may be a contributing cause. Where there is sustained local pressure and a lowering of the hemoglobin level, stasis occurs and local nutrition suffers. Nitrogen balance is hard to maintain in paraplegics or in anyone kept for long at strict