Pressure Sores Development and Healing: Strategies and Progress
Pressure ulcers, also known as bedsores or decubitus ulcers, are injuries to the skin and soft tissue caused by prolonged pressure on a specific body area. These ulcers can occur in bony areas such as the sit bone of the buttocks, the outside of the hip, the tailbone, the heel, the outside of the ankle, and the back of the head.
Preventing pressure ulcers is crucial, and international guidelines recommend a multifactorial approach. This approach includes risk assessment using validated tools like the Braden, Waterlow, or Glamorgan scales to identify patients at risk. Regular repositioning and offloading, every 2 hours, is essential to relieve pressure on vulnerable areas. The use of support surfaces, such as specialized mattresses and cushions that reduce pressure and manage moisture, is also recommended. Skin care management, including keeping skin clean and dry, moisturized, and promptly managing incontinence to prevent maceration, is another key element. Nutrition and hydration optimization to support skin integrity and healing is also important. Ongoing education for healthcare providers on prevention strategies is also recommended to maintain adherence to prevention protocols.
Treatment for pressure ulcers depends on their stage. Symptoms of stage 1 pressure ulcers include an unbroken area of flushed skin, nonblanchable erythema, changes in skin sensation and temperature, loss of skin firmness, and pain. Treatment for stage 1 ulcers involves lowering pressure on the skin, minimizing contact with the ulcer, decreasing moisture, and keeping the area clean.
Stage 2 pressure ulcers involve the epidermis and dermis becoming thinner, and symptoms include a discolored wound, a moist wound, and an intact or ruptured blister. Treatment for stage 2 pressure ulcers involves wound care, nutritional support, and the use of different skin dressings for infected and noninfected skin.
A stage 2 ulcer progresses to a stage 3 ulcer when the wound extends into the subcutaneous tissue, which lies under the dermis and contains fat cells, hair follicles, neurons, and blood vessels. Treatment for stage 3 pressure ulcers may involve the use of hydrogel dressings, calcium alginate dressings, and platelet-derived growth factor to promote healing. Noncontact low frequency ultrasound therapy or high frequency ultrasound therapy may also be recommended as an added treatment for stage 3 pressure ulcer healing.
Stage 4 pressure ulcers extend past the subcutaneous tissue and show significant tissue loss. Treatment for stage 4 pressure ulcers includes similar dressings to those used for stage 3 ulcers, platelet-derived growth factors, various biophysical agents such as pulsed current electrical stimulation, noncontact low frequency ultrasound therapy, high frequency ultrasound therapy, negative pressure wound therapy, and may also require surgery.
Recurrences of pressure ulcers are common, and prevention is the best strategy to avoid complications and long-term treatment. Recovery from an unstageable pressure ulcer may take several weeks to months and can be complicated by other medical conditions such as diabetes and cardiovascular disease. People who have pressure ulcers need immediate treatment to prevent them from progressing, as they can lead to fatal complications.
In summary, international guidelines advocate a multifactorial prevention approach centered on risk assessment, pressure redistribution, skin and moisture management, nutritional support, and staff education. Treatment for pressure ulcers requires efforts from caregivers and healthcare professionals, and an interprofessional team including surgeons, wound care specialists, and specialty-trained nurses is necessary for managing different stages of pressure ulcers.
[1] EPUAP, NPIAP, PPPIA. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. 2019. [2] National Institute of Health and Care Excellence (NICE). Pressure ulcers: prevention and management. 2019. [3] National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. 2019. [4] National Pressure Ulcer Advisory Panel (NPUAP), National Wound Research Advisory Board (NWRAB), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. 2014. [5] National Institute of Health and Care Excellence (NICE). Pressure ulcers: prevention and management. 2014.
- To reduce the risk of accidental falls, which can potentially cause pressure ulcers, mental health assessments are vital to address any psychiatric conditions that might impair balance and mobility.
- Managing chronic diseases like diabetes, cardiovascular diseases, and muscle atrophy is a crucial aspect of health-and-wellness regimens to prevent pressure ulcers, given their impact on skin integrity.
- Incorporating regular skin-care routines with products specifically designed for medical-conditions, such as sensitive or dry skin, can assist in maintaining skin health and preventing pressure ulcers.
