Immobility and decreased sensation can cause major problems related to the skin in the patient with spinal cord injury. Even though the average age of the veteran with a spinal cord injury is increasing, there are still many younger veterans affected by spinal cord injuries. When skin issues arise in this population, the impact is not only physical but also emotional as skin issues sometimes make it difficult for the veteran to remain in their chairs, thereby decreasing mobility and socialization.

Pressure Injuries

Pressure injuries in the patient with spinal cord injury can pose special challenges, such as recurrent hospitalizations, extensive surgeries, and other complications. Pressure relief can pose issues as the veteran loses mobility and independence while offloading. Treatment modalities include local wound care, offloading, nutritional support, and specialty support surfaces (mattress and chair cushion). It is important to monitor the psychological state of the patient as well and provide emotional support during the healing stages of the pressure injury. As we all know, the best intervention for pressure injuries is to prevent them. Teaching patients and caregivers pressure injury prevention modalities is the best tool in our wound care arsenal.

Diabetic Foot Ulcers

Studies suggest that there is an increased prevalence of diabetes among patients with spinal cord injuries, and veterans have a higher incidence of diabetes than the general population of patients with spinal cord injury. Veterans with spinal cord injuries should be educated about lifestyle choices that may increase the incidence of diabetic foot ulcers, such as smoking and drinking, as well as modifiable risk factors, such as obesity, decreased activity, foot care, and dietary factors.

Burns and Lacerations

It is not uncommon to see veterans with spinal cord injuries who sustain burns and lacerations. Many times, these injuries occur as a result of the veteran’s continuing many of the activities he or she engaged in before the spinal cord injury, such as mechanics, working with power tools, sports, and recreation. Because of the lack of sensation, these injuries are often more severe than they would be in the general population. Treatment modalities include local wound care, splinting or bracing the area as needed, suturing, and physical or occupational therapies. It is also important to provide patient education to prevent further injuries, which can vary depending on the mechanism of injury, while still maintaining independence.

Patient and Caregiver Education

Many veterans with spinal cord injuries still maintain a great degree of independence in their daily care to include performing their own wound care. It is essential to provide a treatment plan that the patient can manage himself or herself. Having the patient demonstrate the dressing change can help determine any modifications that need to be made in the treatment plan. Caregivers need to be encouraged to allow the veterans the degree of autonomy that they are capable of for performing their own wound care to maintain their independence and emotional well-being. If there is no caregiver and the veteran is not capable of performing his or her own wound care, it will be appropriate to discuss the implementation of home health care services.

Resources
Cragg JJ, VK, Dvorak M, Krassioukov A, Mancini GB, Borisoff JF. Spinal cord injury and type 2 diabetes. Neurology. 2013;81(21):1864–8.
Department of Veteran Affairs. VA and Spinal Cord injury. Fact Sheet. 2009. https://www.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf. Accessed October 2, 2018.
Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends. J Spinal Cord Med. 2013;36(6):572–85.
LaVela SL, Weaver FM, Goldstein B, et al. Diabetes mellitus in individuals with spinal cord injury or disorder. J Spinal Cord Med. 2006;29(4):387–95.

About the Author
Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN is a Nurse Practitioner at the VA Medical Center in Lake City, Florida. She is the Wound Care Provider in the Out-Patient Clinic serving the Veteran Population of North Florida and South Georgia. Cathy is certified in wound, ostomy and foot care. In addition to her wound care experience, she also has experience in acute care, pediatrics, home health, long-term care and has served as a Professor of Nursing. Cathy’s passion for wound care began while she was working in the long-term care setting as an RN. She serves the veteran population as a memorial to her dad, a combat wounded WWII Veteran.