Authors: Farooq A. Rathore, MBBS P. W. New, MClinEpi, FAFRM (RACP) Akhtar Waheed, MBBS, MCPS, FCPS Affiliations: From the Spinal Rehabilitation Unit (FAR, AW), AF Institute of Rehabilitation Medicine, Rawalpindi, Pakistan; Spinal Rehabilitation Unit (PWN), Caulfield General Medical Centre, Bayside Health, Melbourne, Australia; and Departments of Medicine (PWN) and Epidemiology and Preventive Medicine (PWN), Monash University, Melbourne, Victoria, Australia. Correspondence: All correspondence and requests for reprints should be addressed to Farooq A. Rathore, MBBS, AF Institute of Rehabilitation Medicine, Abid Majeed Rd., Rawalpindi 46000, Pakistan. Disclosures: None. 0894-9115/09/8803-0001/0 American Journal of Physical Medicine & Rehabilitation Copyright © 2009 by Lippincott Williams & Wilkins DOI: 10.1097/PHM.0b013e318198b6d7 Pressure Ulcers in Spinal Cord Injury An Unusual Site and Etiology ABSTRACT Rathore FA, New PW, Waheed A: Pressure ulcers in spinal cord injury: An unusual site and etiology. Am J Phys Med Rehabil 2009;88:000 – 000. Case series of pressure ulcers in patients with spinal cord injury after inappro- priate and prolonged application of graduated compression stockings are pre- sented. Three adult patients with spinal cord injury were fitted with graduated compression stockings in the acute phase to prevent thromboembolism. Acute hospital staff did not monitor the skin for potential pressure ulcer because of the graduated compression stockings. Grade II pressure ulcers developed on the toes in all three cases. All pressure ulcers were managed conservatively and healed without complication. The manufacturers of graduated compression stock- ings did not include information about the need to monitor patients with sensory impairment for pressure ulcers. It is suggested that the manufacturers of gradu- ated compression stockings include information about the need to monitor patients with sensory impairment for skin breakdown. When graduated compres- sion stockings are applied to patients with sensory impairment, including spinal cord injury, staff needs to be vigilant for pressure ulcers occurring at the extremes of the graduated compression stockings, in addition to the more common areas where pressure ulcers occur. Key Words: Pressure Ulcers, Spinal Cord Injury, Thromboprophylaxis, Compression Stockings Pressure ulcers are a frequent complication of spinal cord injury (SCI). 1,2 There are numerous risk factors for developing a pressure ulcer. 2–4 Pressure ulcers may develop anytime after SCI 5 and are among the costliest complica- tions. 6 They are responsible for an increased length of stay in hospital 7 and are an important cause of rehospitalization. 5 This is despite the availability of evidenced-based prevention guidelines. 8 Patients with SCI are also at a high risk of developing thromboembolic disorders: deep vein thrombosis and pulmonary embolism. 9 Graduated com- pression stockings (GCS) fitted to the lower limbs combined with other forms of thromboprophylaxis are one of the effective means of reducing the risk of thrombosis. 10,11 We present three case reports of patients with SCI who devel- oped pressure ulcers secondary to prolonged and inappropriate application of GCS. March 2009 Pressure Ulcers on the Foot in SCI 1 CASE REPORT Pressure Ulcers