Pressure ulcer is also
known as bedsores or decubitus ulcer. They are localized injury to the skin
and/or underlying tissue usually over a bony prominence, as a result of prolonged
pressure on the skin.
The common sites of
pressure ulcers are hip, back, heels, ankles, elbows, knees, or back of head.
People who are confined to bed or wheelchairs are at the threat of developing
advancement, the prevention and treatment of pressure ulcer remains a
A team of scientists
has developed the best possible practice for preventing and treating pressure
ulcers (PrU) by various guidelines.
The treatment consists
of certain key steps such as treatment of the cause, addressing
patient-centered concerns and administering local wound care.
The patients with high
risk for pressure ulcers need to be identified by reviewing their medical
history and current medication profile, assessing the skin periodically and by
using validated risk assessment tools like Braden scale, Waterlow scale and
An important point to
remember is that despite optimal care, not all pressure ulcers are preventable.
Determine the Type of Wound:
For the sake of proper
realistic treatment, healability of the wound is determined and the wound is
classified into following:
Healable wound: the cause is
corrected, there is enough blood supply to heal; moist interactive healing
Maintenance wound: the wound could
heal, but the cause is not corrected due to patient unwillingness to adhere to
treatment or a lack of required system resources
Non-healable wound: the patient is ill
or may have negative protein balance or inadequate blood supply that is not
bypassable or dilatable
Certain other factors
such as systemic disease, medications and nutrition also affect the process of
Treat the Cause:
Pressure and Shear
The prevention of
pressure ulcer is dependent on the reduction of forces of pressure and shear
that are responsible for damaging the skin, muscles and subcutaneous fat.
Pressure can be managed by using pressure management cushions and by
encouraging the patients to reposition themselves when possible.
assessment involves measuring hemoglobin, body mass index (BMI) and serum
albumin level. BMI greater than 20 poses an increased risk of pressure ulcer.
Low hemoglobin levels
of 80-100 delays healing while very low levels of 60-80 severely impair the
wound healing process.
Normal albumin levels
are above 30-33, with delayed healing at levels between 20 and 30, and at
levels greater than 20 it will be very difficult to heal a wound.
Immobility, Level of
Activity and Positioning
Individuals with spinal
cord injuries are prone to develop pressure ulcers. Such patients should
consult a professional and resort to exercise program (e.g., in bed, movements
or positioning during seating, assisted ambulation, and training equipment).
Moisture and Friction
Both friction and
moisture lead to superficial breaking of the skin. Care should be taken to keep
the region dry and free of moisture. Underwear or diapers should be regularly
changed in case of urine and fecal incontinence. Urinary incontinence may be
controlled with intermittent catheterization, a condom catheter, or an
indwelling catheter; however, their use is associated with other complications
Pressure ulcers are
associated with pain. Nociceptive (gnawing ache, tender, and throbbing)
stimulus dependant pain can be treated with acetylsalicylic acid and
nonsteroidal anti-inflammatory drugs and then progressing to narcotic agents.
While neuropathic (burning, stinging, shooting, and stabbing) non-stimulus dependent
pain can be controlled using tricyclic compounds high in noradrenalin activity.
Odor from the wound
dressing needs a treatment against the anaerobic bacteria.
Smoking hampers the
blood flow by 40 percent and causes ischemia and delays healing. Smoking one
cigarette constricts the blood vessels for 90 minutes.
Bed rest leads to
mental and physical degradation hence daily activities should be encouraged to
promote normal and healthy life.
Other Factors Influencing the Treatment:
Type of Pressure
Pressure ulcers are
classified into categories based on their severity.
A suspected deep
tissue injury (sDTI) is characterized by a purple or maroon localized area of
intact skin that may feature a blood filled blister due to damage of the
underlying soft tissue from pressure and/or shear. Not all sDTIs subsequently
ulcerate or breakdown, as they can self resolve.
Location and Size
The healing of an
ulcer depends largely on its size and location. The size is measured to assess
the progress of the treatment.
supply in the lower limbs accounts for the heel ulcers.
Local Wound Care
The wound should be
cleansed gently with low-toxicity solutions such as acetic acid (0.5 to 1.0
percent) or saline. If seepage of the solution is not visible, compresses on
gauze ribbon can be used.
should be properly removed from the wound surface. Autolytic debridement is
often facilitated with dressings (e.g., calcium alginates, hydrogels or
hydrocolloids). Enzymatic (e.g., collagenase) or biological debridement with
maggots may also be used.
balance is needed for proper wound healing. Moisture balancing dressings in the
form of films, hydrogels, hydrocolloids, foams can be used.
The wound should be
protected from bacteria and other microbes. The presence of any three clinical
signs in the mnemonic NERDS (non-healing, exudate increase, red friable or
easily bleeding granulation tissue, new slough or debris on the wound surface,
and smell) indicate severe bacterial colonization. These wounds can be treated
with topical antimicrobials like silver dressings (combined with foams,
alginates or hydrogels, as well as grid or cloth-like structures), PHMB foam
and gauze, iodine (cadexomer iodine or povidone iodine), and honey (alginate,
hydrogel or hydrocolloid).
may be required to treat wounds with increased exudates and smell.
Care should be taken
to avoid persistent inflammation as it can lead to delayed wound healing.
Dressings containing silver, collagen, ibuprofen or oxidized regenerated
cellulose can improve the condition.
and therapeutic ultrasonography are the advanced therapies for the treatment of
pressure ulcers. Wounds with cliff like edges indicate that the healing is
stalled and in such cases, advanced therapies can be effective. For deep
ulcers, surgery is also considered and negative pressure wound therapy is
resorted to when excessive exudates are present.
Though not all ulcers are preventable, ulcers
can be very effectively treated with the coordination of health care
professionals, a proper treatment plan and by encouraging the patients to
adhere to the treatment.