Materiały źródłowe

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care Treatment & Management: Approach Considerations, General Measures for Optimizing Medical Status, Pressure Reduction

  https://emedicine.medscape.com/article/190115-treatment

  Once a pressure injury (pressure ulcer) has developed, immediate treatment is required. Commonly used treatments over the years have included innovative mattresses, ointments, creams, solutions, dressings, ultrasonography (US), ultraviolet (UV) heat lamps, sugar, and surgery. In choosing a treatment strategy, consideration should be given to the stage of the wound and the purpose of the treatment (eg, protection, moisture, or removal of necrotic tissue). […] For stage 1 and 2 pressure injuries, wound care is usually conservative (ie, nonoperative). For stage 3 and 4 lesions, surgical intervention (eg, flap reconstruction) may be required, though some of these lesions must be treated conservatively because of coexisting medical problems. […] With thorough and comprehensive medical management, many pressure injuries may heal completely without the need for surgical intervention. Successful medical management of these injuries relies on the following key principles: Reduction of pressure, Adequate debridement of necrotic and devitalized tissue, Control of infection, Meticulous wound care.

• #1 Bedsores (pressure ulcers) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-sores/diagnosis-treatment/drc-20355899

  Your healthcare professional likely will look closely at your skin to decide if you have a pressure ulcer. If a pressure ulcer is found, your healthcare professional will assign a stage to the wound. Staging helps determine what treatment is best for you. […] Treating pressure ulcers involves lowering pressure on the affected skin, caring for wounds, controlling pain, preventing infection and eating well. […] The first step in treating a bedsore is to lower the pressure and friction that caused it. […] Care for pressure ulcers depends on how deep the wound is. Generally, tending to a wound includes these steps: […] To heal properly, wounds need to be free of damaged, dead or infected tissue. The healthcare professional may remove damaged tissue, also known as debriding, by gently flushing the wound with water or cutting out damaged tissue. […] A large bedsore that fails to heal might require surgery. One method of surgical repair is to use padding from your muscle, skin or other tissue to cover the wound and cushion the affected bone. This is called flap surgery.

• #1 Stages of Pressure Ulcers: Stages, Treatments, and More

  https://www.healthline.com/health/stages-of-pressure-ulcers

  Preventative strategies can help reduce the risk of bedsores. These include but are not limited to: changing positions every 2 to 3 hours in bed or every 15 minutes in a wheelchair. […] If you begin experiencing symptoms with skin changes or pain from immobilization, seek immediate medical attention.

• #1 Pressure ulcers | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/pressure-ulcers/

  Pressure ulcers are areas of damage to the skin and the tissue underneath. This happens when an area of skin is put under pressure. […] Pressure ulcers can also be known as pressure sores or bed sores. […] The type of treatment you get will depend on how severe the pressure ulcer is. […] Changing position and moving regularly is important to help relieve pressure on the ulcers. It can also help to stop new ones from forming. […] Other treatments include: specially designed mattresses and cushions, dressings to protect the ulcer and help it heal, creams and ointments, antibiotics (if the ulcer is infected), cleaning the ulcer. […] If the pressure ulcer is severe or other treatments haven’t worked, you may need to have surgery. This is to clean and close the ulcer. […] How quickly pressure ulcers heal will be different for everyone. […] It can depend on: your treatment plan, how severe the ulcer is, your nutrition, if there’s an infection, if you have any other health conditions. […] If you’re worried that your ulcer isn’t healing, speak to a healthcare professional.

• #1 How to care for pressure sores Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/selfcare-instructions/how-to-care-for-pressure-sores

  Pressure sores occur when there is too much pressure on the skin for too long. This reduces blood flow to the area. Without enough blood to nourish the skin, the skin can die and a sore may form. […] Stage I or II sores will often heal if cared for carefully. Stage III and IV sores are harder to treat and may take a long time to heal. Here’s how to care for a pressure sore at home. […] Relieve the pressure on the area. […] Care for the sore as directed by your provider. Keep the wound clean to prevent infection. Clean the sore every time you change a dressing. […] Most stage III and IV sores will be treated by your provider. Ask about any special instructions for home care. […] Do not massage the skin near or on the ulcer. This can cause more damage. Do not use donut-shaped or ring-shaped cushions. They reduce blood flow to the area, which may cause sores.

• #1 How to care for pressure sores: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000740.htm

  Do not massage the skin near or on the ulcer. This can cause more damage. Do not use donut-shaped or ring-shaped cushions. They reduce blood flow to the area, which may cause sores. […] Contact your provider if you develop blisters or an open sore. […] Call immediately if there are signs of infection, such as: A foul odor from the sore, Pus coming out of the sore, Redness and tenderness around the sore, Skin close to the sore is warm and/or swollen, Fever. […] Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians.

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/190115-overview

  Although the terms decubitus ulcer, pressure sore, and pressure ulcer have often been used interchangeably, the National Pressure Injury Advisory Panel (NPIAP; formerly the National Pressure Ulcer Advisory Panel [NPUAP]) has stated that pressure injury the best term to use, given that open ulceration does not always occur. According to the NPIAP, a pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful. It occurs as a result of intense or prolonged pressure or pressure in combination with shear. […] For the purposes of workup and treatment, it is helpful to stage the pressure injury according to the system promulgated by the NPIAP, as follows: Stage 1 pressure injury – Nonblanchable erythema of intact skin; Stage 2 pressure injury – Partial-thickness skin loss with exposed dermis; Stage 3 pressure injury – Full-thickness skin loss; Stage 4 pressure injury – Full-thickness skin and tissue loss; Unstageable pressure injury – Obscured full-thickness skin and tissue loss; Deep pressure injury – Persistent nonblanchable deep red, maroon or purple discoloration.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html/1000

  A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. […] Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. […] Debridement is indicated when necrotic tissue is present. […] Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. […] Topical antibiotics should be considered if there is no improvement in healing after 14 days. […] Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection. […] The management of pressure ulcers is interdisciplinary, including primary care physicians, dermatologists, infectious disease consultants, social workers, psychologists, dietitians, podiatrists, home and wound-care nurses, rehabilitation professionals, and surgeons.

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/190115-overview

  General principles of wound assessment and treatment are as follows: Wound care may be broadly divided into nonoperative and operative methods; For stage 1 and 2 pressure injuries, wound care is usually conservative (ie, nonoperative); For stage 3 and 4 lesions, surgical intervention (eg, flap reconstruction) may be required, though some of these lesions must be treated conservatively because of coexisting medical problems; Approximately 70%-90% of pressure injuries are superficial and heal by second intention. […] Successful medical management of pressure injuries relies on the following key principles: Reduction of pressure; Adequate debridement of necrotic and devitalized tissue; Control of infection; Meticulous wound care. […] Additional nonsurgical treatment measures include the following: Pressure reduction – Repositioning and use of support surfaces; Wound management – Debridement, cleansing agents, dressings, and antimicrobials; Newer approaches still being studied – Growth factors (eg, becaplermin), negative-pressure wound therapy, and electrotherapy.

• #1 A Guide on Detecting and Treating Pressure Sores | MSKTC

  https://msktc.org/sci/factsheets/recognizing-and-treating-pressure-sores

  One of the first signs of a possible skin sore is a reddened, discolored or darkened area (an African Americans skin may look purple, bluish or shiny). It may feel hard and warm to the touch. […] A pressure sore has begun if you remove pressure from the reddened area for 10 to 30 minutes and the skin color does not return to normal after that time. Stay off the area and follow instructions under Stage 1, below. Find and correct the cause immediately. […] Pressure Sore stage 1 Signs: Skin is not broken but is red or discolored or may show changes in hardness or temperature compared to surrounding areas. When you press on it, it stays red and does not lighten or turn white (blanch). The redness or change in color does not fade within 30 minutes after pressure is removed. […] What to do: Stay off area and remove all pressure. Keep the area clean and dry. Eat adequate calories high in protein, vitamins (especially A and C) and minerals (especially iron and zinc). Drink more water. Find and remove the cause. Inspect the area at least twice a day. Call your health care provider if it has not gone away in 2-3 days.

• #1 Bed Sore Treatment: Home Remedies for Bed Sores | UPMC HealthBeat

  https://share.upmc.com/2017/08/home-bedsores-treatment/

  Special mattresses and assistive devices can help relieve pressure on the body. Specially designed foam, low air pressure mattresses, and sheepskin overlays can reduce skin irritation. Ask your doctor for suggestions on pressure-relieving devices and methods. […] Keep skin clean and dry, especially of bodily fluids. […] If you believe you or a loved one is suffering from pressure sores, treatment is necessary. Contact a doctor right away for guidance. […] Treatment for bed sores depends on the stage and depth of the wound. […] You can clean stage-one ulcers with mild soap and water and cover with a moisture-barrier lotion. […] More advanced bed sores may require medical care. Your care team may clean the wound with saline and cover it with a special bandage. […] If a wound becomes infected, you may need to take antibiotics.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  The management of pressure ulcers is interdisciplinary, including primary care physicians, dermatologists, infectious disease consultants, social workers, psychologists, dietitians, podiatrists, home and wound-care nurses, rehabilitation professionals, and surgeons. […] The pressure-reducing devices used in preventive care also apply to treatment. […] Pain assessment should be completed, especially during repositioning, dressing changes, and debridement. […] Necrotic tissue promotes bacterial growth and impairs wound healing, and it should be debrided until eschar is removed and granulation tissue is present. […] Wounds should be cleansed initially and with each dressing change. […] Dressings that maintain a moist wound environment facilitate healing and can be used for autolytic debridement.

• #1 Treating Pressure Injuries: Cleaning and Dressing

  https://www.veteranshealthlibrary.va.gov/encyclopedia/142,84022_VA

  Adding moisture […] Keeping a clean, moist wound bed is important for promoting healing. Certain dressings help keep injuries moist. Fill spaces loosely with dressings (do not pack). This will prevent fluid and bacteria from building up. Wound gels (such as hydrogels) can also help keep it moist. The skin around the wound or injury should be protected from moisture or drainage. This can be done by keeping the dressing materials only on the open area or using a skin protectant on the surrounding skin. […] Types of dressings […] Many kinds of dressings are available. Be sure to follow the manufacturers instructions for the specific dressing used. If a wound doesnt respond to one type of dressing, talk with your healthcare provider about changing the treatment plan. Certain types of dressings interact with moisture from the injury and can be mistaken for infected drainage. As the injuries heal, the type of dressing used could change also. […] Skin protectant. A skin protectant plays an important role in managing the skin, especially skin around the wound. It is a thin barrier or layer which can be put on damaged skin or over skin which is at risk of damage.

• #1 Bedsores (pressure ulcers): Treatments, stages, causes, and pictures

  https://www.medicalnewstoday.com/articles/173972

  Apply dressings: These protect the wound and accelerate healing. Options that are antimicrobial or hydrocolloid, or that contain alginic acid, may be best. Dressings are available for purchase online. […] Use topical creams: Antibacterial creams can help combat an infection, while barrier creams can protect damaged or vulnerable skin. […] Have dead tissue removed: This can help a sore heal. A healthcare provider may use a high-pressure water jet or surgical instruments. […] Discuss surgical options: These might include removing dead tissue, cleaning the wound, and closing the edges as far as possible. The surgeon may take tissue from healthy skin to perform the repair. […] A person with bedsores may also benefit from vacuum-assisted wound closure, electrical stimulation, and hyperbaric oxygen therapy. […] It is often possible to reduce the risk of pressure sores. When a sore is at an early stage, a person can treat it at home, but more advanced pressure ulcers require professional care. […] It is best to take every step to prevent these sores and to treat them early if they form.

• #1 A Guide on Detecting and Treating Pressure Sores | MSKTC

  https://msktc.org/sci/factsheets/recognizing-and-treating-pressure-sores

  Healing time: A pressure sore at this stage can be reversed in about three days if all pressure is taken off the site. […] Pressure Sore stage 2 Signs: The topmost layer of skin (epidermis) is broken, creating a shallow open sore. The second layer of skin (dermis) may also be broken. Drainage (pus) or fluid leakage may or may not be present. […] What to do: Get the pressure off. Follow steps in Stage 1. See your health care provider right away. […] Healing time: Three days to three weeks. […] Pressure Sore stage 3 Signs: The wound extends through the dermis (second layer of skin) into the fatty subcutaneous (below the skin) tissue. Bone, tendon and muscle are not visible. Look for signs of infection (redness around the edge of the sore, pus, odor, fever, or greenish drainage from the sore) and possible necrosis (black, dead tissue).

• #1 How to care for pressure sores: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000740.htm

  A pressure sore is an area of the skin that breaks down when something keeps rubbing or pressing against the skin. […] Pressure sores occur when there is too much pressure on the skin for too long. This reduces blood flow to the area. Without enough blood to nourish the skin, the skin can die and a sore may form. […] Stage I or II sores will often heal if cared for carefully. Stage III and IV sores are harder to treat and may take a long time to heal. Here’s how to care for a pressure sore at home. […] Relieve the pressure on the area. […] Care for the sore as directed by your provider. Keep the wound clean to prevent infection. Clean the sore every time you change a dressing. […] Most stage III and IV sores will be treated by your provider. Ask about any special instructions for home care.

• #1 Bedsores (Pressure Ulcers): Symptoms, Staging & Treatment

  https://my.clevelandclinic.org/health/diseases/17823-bedsores-pressure-injuries

  To treat a pressure injury, you or your healthcare provider may: irrigate or clean the wound with soap and water or saline (sterile saltwater solution); dress (cover) the wound with special medical bandages designed to promote healing. These include water-based gel (hydrogel), hydrocolloid, alginates (seaweed) and foam dressings. […] For deep, severe pressure ulcers, your healthcare provider will remove dead tissue during a procedure called debridement. Your provider removes the dead tissue using a scalpel. Or they may apply ointments that help your body dissolve the dead tissue. […] Stages 3 or 4 pressure sores that are deep or affect a large area of skin may require surgery. You may need a skin graft to close the wound and promote healing.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  A trial of topical antibiotics, such as silver sulfadiazine cream (Silvadene), should be used for up to two weeks for clean ulcers that are not healing properly after two to four weeks of optimal wound care. […] Surgical consultation should be obtained for patients with clean stage III or IV ulcers that do not respond to optimal patient care or when quality of life would be improved with rapid wound closure. […] Growth factors (e.g., platelet-derived growth factor becaplermin [Regranex]) and vacuum-assisted closure for recalcitrant stage III and IV ulcers are emerging management options.

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care Treatment & Management: Approach Considerations, General Measures for Optimizing Medical Status, Pressure Reduction

  https://emedicine.medscape.com/article/190115-treatment

  The choice of wound dressings varies with the state of the wound, the goal being to achieve a clean, healing wound with granulation tissue. […] Hydrocolloid dressings form an occlusive barrier over the wound while maintaining a moist wound environment and preventing bacterial contamination. […] Vacuum-assisted closure (VAC) sponges conform to the wound surface by suction and stimulate wound contracture while removing exudate and edema. […] Even with optimal medical management, many patients require a trip to the operating room for debridement, diversion of the urinary or fecal stream, release of flexion contractures, wound closure, or amputation. […] Reconstruction of a pressure injury is aimed at improvement of patient hygiene and appearance, prevention or resolution of osteomyelitis and sepsis, reduction of fluid and protein loss through the wound, and prevention of future malignancy (Marjolin ulcer).

• #1 A Guide on Detecting and Treating Pressure Sores | MSKTC

  https://msktc.org/sci/factsheets/recognizing-and-treating-pressure-sores

  What to do: If you have not already done so, get the pressure off and see your health care provider right away. Wounds in this stage frequently need special wound care. You may also qualify for a special bed or pressure-relieving mattress that can be ordered by your health care provider. […] Healing time: More than one to four months. […] Pressure Sore stage 4 Signs: The wound extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present. There is a high possibility of infection. […] What to do: Always consult your health care provider right away. Surgery is frequently required for this type of wound. […] Healing time: Anywhere from three months to two years. […] Possible complications of pressure sores: Can be life threatening. Infection can spread to the blood, heart and bone. Amputations. Prolonged bed rest that can keep you out of work, school and social activities for months. Autonomic dysreflexia. Because you are less active when healing a pressure sore, you are at higher risk for respiratory problems or urinary tract infections (UTIs). Treatment can be very costly in lost wages or additional medical expenses.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. […] Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. […] Debridement is indicated when necrotic tissue is present. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs. […] Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. […] Topical antibiotics should be considered if there is no improvement in healing after 14 days. Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection.

• #1 Pressure Ulcers: Treatment and Management | Doctor

  https://patient.info/doctor/pressure-ulcers-pro

  Infection control: All pressure ulcers are colonised with bacteria. Most local infection can be managed using antimicrobial wound products; systemic antibiotics should not be used routinely for local infection. […] The simplest method for debriding necrotic tissue involves careful use of a sterile scalpel with adequate analgesia or anaesthesia. Alternative approaches include the use of topical hydrating products, such as hydrogels, cadexomer iodine beads or larval therapy. […] There is no evidence that electromagnetic therapy (EMT), in which electrodes produce an electromagnetic field across the wound, improve healing of pressure ulcers. […] Patients at risk of pressure ulcer development should be positioned to minimise pressure, friction, shear and the potential for further tissue damage.

• #1 Pressure Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553107/

  Pressure injuries are localized skin and soft tissue injuries that develop due to prolonged pressure exerted over specific areas of the body, typically bony prominences. These injuries demand prompt treatment to prevent potential lethal complications. […] Evaluation and treatment options must consider the latest guidelines and classifications by the National Pressure Injury Advisory Panel and the International Statistical Classification of Diseases and Related Health Problems (ICD-11). […] Before discussing different treatments for pressure ulcers, it is essential to emphasize that prevention intervention is the best treatment. Prevention consists of maintaining and improving tissue tolerance and appropriate offloading. This could be achieved through excellent skincare, adequate hydration/nutrition, pressure dispersion cushions, turning schedules, and support surfaces. […] After forming a pressure ulcer, actively offload the affected anatomical area, ensure adequate drainage if an infection is present, debride devitalized tissue, and provide optimal wound care. […] Mechanical debridement is usually necessary to remove devitalized tissue and biofilms that prevent wound healing. […] Dressings can vary according to the ulcer stage, infection, and presence of exudate. However, according to NPIAP, the recommended dressing is foam silicone dressings. […] Surgical management aims to fill the dead space and provide durable skin through flap reconstruction. […] The treatment of decubitus ulcers has its basis in the following: prevention of additional ulcers, decreasing pressure on the wound, wound management, surgical intervention, and improving the nutritional status. Generally, stage 1 and 2 ulcers do not require operative measures; stage 3 and 4 ulcers may require surgical intervention.

• #1 Wound Care for Treating and Preventing a Pressure Ulcer

  https://westcoastwound.com/wound-care-for-pressure-ulcers/

  There is specialized equipment to help alleviate pressure on the wound site. […] If your ulcer is very severe, a sophisticated system with an air pump may be recommended by your doctor. […] While stage 3 and 4 pressure ulcers should be cleaned and treated by a wound care specialist, there are things you can do to care for wounds that are in the first two stages. […] Gently washing the area with mild soap and water is sufficient to help a Stage I sore, while saline (salt water) or specific cleaner can be used for Stage II sores to remove loose, dead tissue. […] A wound care specialist may recommend wound dressings that can help keep the site clean and dry to avoid infection. […] Instead, specially designed dressings like those made from alginate (with seaweed, containing sodium and calcium), hydrocolloid (with a gel that enhances cellular growth), and hydrofibers are often used.

• #1 Pressure Ulcers: Treatment and Management | Doctor

  https://patient.info/doctor/pressure-ulcers-pro

  Pressure-relieving equipment – eg, alternating pressure systems – redistributes the load or relieves the pressure at regular intervals. Pressure-reducing equipment redistributes pressure by spreading the weight over a larger surface area – eg, mattresses, cushions and dynamic air loss systems. […] There is no conclusive research evidence to guide clinicians’ decision-making about which dressings are most effective in pressure ulcer management. The ideal dressing should be easy to apply and remove, have low allergenic potential, be sterile and impermeable to micro-organisms, provide a moist environment but remove excess exudate, reduce pain and not add to wound debris. […] An assessment of the need to debride a pressure ulcer in adults should be undertaken, which takes into consideration: The amount of necrotic tissue. The grade, size and extent of the pressure ulcer. Patient tolerance. Any comorbidities. […] For deep pressure ulcers not responding to standard care, surgery can offer a rapid closure for some patients. This is usually undertaken by plastic surgeons and often involves creating rotational flaps.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html/1000

  The basic components of pressure ulcer management are reducing or relieving pressure on the skin, debriding necrotic tissue, cleansing the wound, managing bacterial load and colonization, and selecting a wound dressing. […] Pain assessment should be completed, especially during repositioning, dressing changes, and debridement. […] Necrotic tissue promotes bacterial growth and impairs wound healing, and it should be debrided until eschar is removed and granulation tissue is present. […] Wounds should be cleansed initially and with each dressing change. […] Dressings that maintain a moist wound environment facilitate healing and can be used for autolytic debridement. […] A trial of topical antibiotics, such as silver sulfadiazine cream (Silvadene), should be used for up to two weeks for clean ulcers that are not healing properly after two to four weeks of optimal wound care.

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/190115-overview

  Surgical interventions that may be warranted include the following: Surgical debridement; Diversion of the urinary or fecal stream; Release of flexion contractures; Wound closure; Amputation. […] Options available for surgical management of pressure injuries are as follows: Direct closure (rarely usable for pressure injuries being considered for surgical treatment); Skin grafts; Skin flaps; Myocutaneous (musculocutaneous) flaps; Free flaps. […] Prevention, if achievable, is optimal. Prevention of pressure injuries has two main components: Identification of patients at risk; Interventions designed to reduce the risk.

• #1 Pressure Injuries (Pressure Ulcers) and Wound Care Treatment & Management: Approach Considerations, General Measures for Optimizing Medical Status, Pressure Reduction

  https://emedicine.medscape.com/article/190115-treatment

  The first step is adequate excision of the injury, including the bursa or lining, surrounding scar tissue, and any heterotopic calcification found. […] Several options are available for surgical management of pressure injuries, including direct closure, skin grafting, skin flaps, and musculocutaneous flaps. […] The patient should be medically stable and able to benefit from the procedure. […] The nutritional status of the patient must be considered because good nutritional parameters are required for good wound healing and immune function. […] After successful wound closure, ambulatory patients should be out of bed with assistance as soon as possible. […] Although in principle, pressure injuries are preventable and should not occur, they continue to be among the most pervasive and perplexing problems encountered in the treatment of persons who are ill, recovering from illness, or functionally impaired. […] Effective prevention of pressure injuries depends on a comprehensive care plan that includes strategies and practices aimed at reducing or eliminating the risk of these injuries.

• #1 Pressure Sores – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores

  Doctors usually try to treat pain with acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) rather than with opioids. […] Superficial infections can sometimes be treated with antibiotics that are applied directly to the skin. […] Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming. […] Deep or large pressure sores are difficult to treat. Sometimes they need to be closed with skin grafts and flaps with skin and sometimes muscle. […] The prognosis for early-stage pressure sores is excellent if people have received timely, appropriate treatment, but healing typically requires weeks. […] Prevention is the best strategy for dealing with pressure sores.

• #1 Pressure ulcers | informedhealth.org

  https://www.informedhealth.org/pressure-ulcers.html

  For stage 3 and 4 wounds, a technique called debridement is used as well to remove dead tissue. […] Proper wound care and the correct positioning can help to prevent pain or at least lessen it. If that isn’t enough, local anesthetics are an option. Wound dressings that contain painkillers may also be used. […] Oral medication like acetaminophen (paracetamol) or ibuprofen tablets can help relieve mild to moderate pain. Doctors can prescribe stronger painkillers if needed.

• #1 Symptoms & Treatments of Pressure ulcers on heel

  https://legsmatter.org/information-and-support/types-of-ulcers/pressure-ulcers/

  Pressure ulcers (also known as pressure sores or bedsores) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. […] Adults with pressure ulcers should be assessed and managed by healthcare professionals with the necessary skills and competencies. […] If the person is assessed as being at risk of nutritional deficiency, refer to a dietitian to provide: Advice on how to follow a balanced diet to maintain an adequate nutritional status, taking into account energy, protein, and micronutrient requirements. […] Recommend high-specification foam mattresses for adults with a pressure ulcer. If this is not sufficient to redistribute pressure, consider the use of a dynamic support surface. […] Consider the need for wound debridement. […] Offer systemic antibiotics only if there is clinical evidence of systemic sepsis, spreading cellulitis, or underlying osteomyelitis.

• #1 Northwest Regional Spinal Cord Injury System

  https://sci.washington.edu/info/newsletters/articles/02sp_prevent_ulcer.asp

  According to James, the most common and least recognized systemic abnormality evident in patients with non-healing wounds is protein-calorie malnutrition (PCM), characterized by protein catabolism and loss of lean body mass (LBM). […] Nutritional supplementation with a high protein content is necessary but not sufficient to reverse the catabolic process. […] The medication oxandrolone, an agent that is structurally similar to testosterone, can help correct this. […] Once a pressure ulcer is present, the patient is already in a catabolic state, James said. […] Recent evidence collected and analyzed by James and other researchers at the Seattle VA now suggests that „patients who start out with decreased albumin and other metabolic deficiencies are predisposed to getting pressure ulcers because of their catabolic state, regardless of their pressure releases,” James said.

• #1 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html/1000

  Surgical consultation should be obtained for patients with clean stage III or IV ulcers that do not respond to optimal patient care or when quality of life would be improved with rapid wound closure. […] Growth factors (e.g., platelet-derived growth factor becaplermin [Regranex]) and vacuum-assisted closure for recalcitrant stage III and IV ulcers are emerging management options.

• #1 Treatment for Bed Sores: Who, When, Why, and What’s Next? – Net HealthExpandExpandExpandExpandSearchToggle MenuLinkedinFacebookXExpandExpandExpandExpandToggle Menu CloseSearch

  https://www.nethealth.com/blog/treatment-bed-sores-who-when-why-whats-next/

  All bed sores should be cleaned, typically with a gentle saline solution, and the majority will need to be dressed. Pay close attention to the moisture balance when dressing the wound and tending to the pressure sore. Too much or not enough moisture can inhibit proper wound healing of pressure injuries. Additionally, a balanced diet is key to maintaining good health in general, but healthy eating has the added benefit of encouraging wound healing. […] Negative pressure wound therapy (NPWT) continues to be an effective treatment for complex bed sores. This therapy applies controlled negative pressure to a wound, which helps remove exudate, reduce edema, and promote perfusion, accelerating the healing process. […] Hyperbaric oxygen therapy (HBOT) is another promising treatment option for non-healing wounds. Patients are placed in a chamber with 100% oxygen, a higher percentage than the air we breathe daily. By increasing the oxygen supply to the affected area, HBOT enhances the body’s natural healing process. This therapy can be particularly beneficial for patients with chronic, non-responsive bed sores or pressure ulcers, an advanced wound care option that offers a potential solution for wounds that have not responded to conventional treatments. […] The AHRQ estimates that up to 60% of pressure ulcers are preventable through proper care and protocols.

• #1 Pressure ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Pressure_ulcer

  Recommendations to treat pressure ulcers include the use of bed rest, pressure redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation). […] Necrotic tissue should be removed in most pressure ulcers. […] It is not clear if one topical agent or dressing is better than another for treating pressure ulcers. […] Other treatments include anabolic steroids, medical grade honey, negative pressure wound therapy, phototherapy, pressure relieving devices, reconstructive surgery, support surfaces, ultrasound and topical phenytoin.

• #1 Negative pressure wound therapy for treating pressure ulcers | Cochrane

  https://www.cochrane.org/CD011334/WOUNDS_negative-pressure-wound-therapy-treating-pressure-ulcers

  Negative pressure wound therapy for treating pressure ulcers […] Pressure ulcers, also known as bedsores, decubitus ulcers, and pressure injuries, are areas of injury to the skin, the tissue that lies underneath, or both. […] There is a wide variety of treatment options available for pressure ulcers, such as dressings, reconstructive surgery, redistribution of pressure, electrical stimulation, and negative pressure wound therapy (NPWT). […] The aim of this review is to find out whether the use of NPWT is effective in the treatment of pressure ulcers in any care setting. […] We found eight studies published between 2002 and 2022 involving a total of 327 participants with pressure ulcers at Category/Stage III or above. […] The current evidence on the efficacy of NPWT in the treatment of pressure ulcers is limited, and most studies were small (median 37 participants), poorly reported, of fairly short or unclear duration, and contained little in the way of useful data. […] The efficacy, safety, and acceptability of NPWT in treating pressure ulcers compared to usual care are uncertain due to the lack of key data on complete wound healing, adverse events, time to complete healing, and cost-effectiveness. […] Compared with usual care, using NPWT may speed up the reduction of pressure ulcer size and severity of pressure ulcer, reduce pain, and dressing change times. […] In the future, high-quality research with large sample sizes and low risk of bias is still needed to further verify the efficacy, safety, and cost-effectiveness of NPWT in the treatment of pressure ulcers.

• #1 Pressure Sores | Bedsores | Pressure Ulcers | MedlinePlus

  https://medlineplus.gov/pressuresores.html

  Pressure sores are areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips. You are at risk if you are bedridden, use a wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which are life-threatening. They can be a problem for people in nursing homes. […] You can prevent the sores by: Keeping skin clean and dry, Changing position every two hours, Using pillows and products that relieve pressure. […] Pressure sores have a variety of treatments. Advanced sores are slow to heal, so early treatment is best. […] How to care for pressure sores. […] Preventing pressure ulcers.

• #1 Bedsores (pressure ulcers) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893

  Bedsores are areas of damaged skin and tissue caused by sustained pressure that reduces blood flow to vulnerable areas of the body. This pressure may be caused from being in a bed or wheelchair for a long time. […] Bedsores can arise over hours or days. Most sores heal with treatment, but some never heal completely. You can take steps to put a stop to bedsores and help them heal. […] If you notice warning signs of a bedsore, change your position to ease pressure on the area. If the area doesn’t improve in 24 to 48 hours, contact your healthcare professional. […] You can help stop bedsores with these steps: Frequently change your position to avoid stress on the skin. […] Consider these recommendations related to changing position in a bed or chair: Shift your weight frequently. Ask for help with changing your position every two hours. […] Consider these suggestions for skin care: Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to limit the skin’s exposure to moisture, urine and stool.

• #1 Causes and prevention of pressure sores | Coping with cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/skin-problems/pressure-sores/causes-and-prevention

  A nurse or doctor must examine you when you have a pressure ulcer. They can offer ways of managing and treating a pressure ulcer. […] It is much better to prevent pressure sores than to treat them. […] The National Institute for Health and Care Excellence (NICE) has guidelines on pressure sores. […] They should also create a plan to prevent them. […] The following tips can help to prevent pressure sores: […] use special pressure relieving mattresses and cushions. […] keep your skin clean and dry. […] eat a well balanced diet. […] tell your doctor or nurse if you notice any skin changes or discomfort as soon as possible.

• #1 PHYSICAL THERAPY GUIDE TO BED SORES – Therapy West PT & Sports Medicine

  https://therapywestpt.com/physical-therapy-guide-to-bed-sores/

  Based on the examination, the physical therapist will decide whether any further testing or consultation with another health care provider is necessary. In some cases, surgery or the prescription of antibiotics by a physician may be necessary. […] Because pressure ulcers are usually the result of prolonged contact of a body part with a bed or chair, repositioning or moving a person back and forth between a bed and a chair is needed to help pressure ulcers heal. […] The physical therapist will discuss what to expect in terms of normal wound healing, signs to look for that might indicate a problem between visits, and when to contact a physician or an emergency department. […] If no changes are made to the care of a person who has developed a pressure ulcer, another pressure ulcer is likely to develop in the same or a different place on the body. To help reduce the risk of a new ulcer, the physical therapist trains caregivers in positioning, transferring, and selecting support surfaces. […] The therapist teaches the family how to clean and dress the wound and evaluates Ellen’s potential for greater mobility, showing the family how to reposition and transfer her from one surface to another.

• #1 Quick Safety 25: Preventing pressure injuries (Updated March 2022) | The Joint CommissionfacebookXlinkedin

  https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-25-preventing-pressure-injuries/preventing-pressure-injuries/

  Pressure injuries are significant health issues and one of the biggest challenges organizations face on a day-to-day basis. […] Pressure injury treatment is costly, but the development of pressure injuries can be prevented by using evidence-based nursing practice. […] The prevention of pressure injuries is a great concern in health care today. Many clinicians believe that pressure injury development is not solely the responsibility of nursing, but the entire health care system. […] Pressure injury prevention and treatment requires multi-disciplinary collaborations, good organizational culture and operational practices that promote safety. […] Protecting and monitoring the condition of the patient’s skin is important for preventing pressure sores and identifying Stage 1 sores early so they can be treated before they worsen. […] Hospitalized individuals are at great risk for undernutrition. […] Immobility can be a big factor in causing pressure injuries. […] In any type of process improvement or initiative, implementation will be difficult without the right training, monitoring and leadership support.

• #2 Pressure Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553107/

  Pressure injuries are localized skin and soft tissue injuries that develop due to prolonged pressure exerted over specific areas of the body, typically bony prominences. These injuries demand prompt treatment to prevent potential lethal complications. […] Evaluation and treatment options must consider the latest guidelines and classifications by the National Pressure Injury Advisory Panel and the International Statistical Classification of Diseases and Related Health Problems (ICD-11). […] Before discussing different treatments for pressure ulcers, it is essential to emphasize that prevention intervention is the best treatment. Prevention consists of maintaining and improving tissue tolerance and appropriate offloading. This could be achieved through excellent skincare, adequate hydration/nutrition, pressure dispersion cushions, turning schedules, and support surfaces. […] After forming a pressure ulcer, actively offload the affected anatomical area, ensure adequate drainage if an infection is present, debride devitalized tissue, and provide optimal wound care. […] Mechanical debridement is usually necessary to remove devitalized tissue and biofilms that prevent wound healing. […] Dressings can vary according to the ulcer stage, infection, and presence of exudate. However, according to NPIAP, the recommended dressing is foam silicone dressings. […] Surgical management aims to fill the dead space and provide durable skin through flap reconstruction. […] The treatment of decubitus ulcers has its basis in the following: prevention of additional ulcers, decreasing pressure on the wound, wound management, surgical intervention, and improving the nutritional status. Generally, stage 1 and 2 ulcers do not require operative measures; stage 3 and 4 ulcers may require surgical intervention.

• #2 Treatment of pressure sores | Coping with cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/skin-problems/pressure-sores/treatment

  Pressure sores develop when the skin breaks down and creates a wound. There is a risk that the wound can get infected. This can be a serious problem. It is very important to treat infections quickly. […] A nurse or doctor must examine you. District nurses can visit and advise on how to look after your skin if you are at home. In hospitals, there are specialist nurses known as tissue viability nurses. They have training in treating pressure sores. They can advise you on the best treatment. […] It can take a long time for pressure sores to heal. […] If you develop a pressure sore, it is vital to relieve pressure on the area. Depending on your situation, this may be from as often as every 15 minutes to every 6 hours. The best way to do this is by not lying or sitting on that skin area. […] Several types of special mattresses and cushions can relieve pressure on pressure areas of the body. Your healthcare team will tell you more about the types of mattresses and cushions for your situation.

• #2 Bedsores (pressure ulcers) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893

  Bedsores are areas of damaged skin and tissue caused by sustained pressure that reduces blood flow to vulnerable areas of the body. This pressure may be caused from being in a bed or wheelchair for a long time. […] Bedsores can arise over hours or days. Most sores heal with treatment, but some never heal completely. You can take steps to put a stop to bedsores and help them heal. […] If you notice warning signs of a bedsore, change your position to ease pressure on the area. If the area doesn’t improve in 24 to 48 hours, contact your healthcare professional. […] You can help stop bedsores with these steps: Frequently change your position to avoid stress on the skin. […] Consider these recommendations related to changing position in a bed or chair: Shift your weight frequently. Ask for help with changing your position every two hours. […] Consider these suggestions for skin care: Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to limit the skin’s exposure to moisture, urine and stool.

• #2 Pressure Ulcers: Treatment and Management | Doctor

  https://patient.info/doctor/pressure-ulcers-pro

  Pressure-relieving equipment – eg, alternating pressure systems – redistributes the load or relieves the pressure at regular intervals. Pressure-reducing equipment redistributes pressure by spreading the weight over a larger surface area – eg, mattresses, cushions and dynamic air loss systems. […] There is no conclusive research evidence to guide clinicians’ decision-making about which dressings are most effective in pressure ulcer management. The ideal dressing should be easy to apply and remove, have low allergenic potential, be sterile and impermeable to micro-organisms, provide a moist environment but remove excess exudate, reduce pain and not add to wound debris. […] An assessment of the need to debride a pressure ulcer in adults should be undertaken, which takes into consideration: The amount of necrotic tissue. The grade, size and extent of the pressure ulcer. Patient tolerance. Any comorbidities. […] For deep pressure ulcers not responding to standard care, surgery can offer a rapid closure for some patients. This is usually undertaken by plastic surgeons and often involves creating rotational flaps.

• #2 A Guide on Detecting and Treating Pressure Sores | MSKTC

  https://msktc.org/sci/factsheets/recognizing-and-treating-pressure-sores

  One of the first signs of a possible skin sore is a reddened, discolored or darkened area (an African Americans skin may look purple, bluish or shiny). It may feel hard and warm to the touch. […] A pressure sore has begun if you remove pressure from the reddened area for 10 to 30 minutes and the skin color does not return to normal after that time. Stay off the area and follow instructions under Stage 1, below. Find and correct the cause immediately. […] Pressure Sore stage 1 Signs: Skin is not broken but is red or discolored or may show changes in hardness or temperature compared to surrounding areas. When you press on it, it stays red and does not lighten or turn white (blanch). The redness or change in color does not fade within 30 minutes after pressure is removed. […] What to do: Stay off area and remove all pressure. Keep the area clean and dry. Eat adequate calories high in protein, vitamins (especially A and C) and minerals (especially iron and zinc). Drink more water. Find and remove the cause. Inspect the area at least twice a day. Call your health care provider if it has not gone away in 2-3 days.

• #2 Pressure Sores – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores

  Pressure sores are areas of skin damage resulting from a lack of blood flow due to prolonged pressure. […] Treatment includes cleansing, reducing pressure on the affected area, special dressings, and sometimes antibiotics and/or surgery. […] With appropriate treatment, early-stage pressure sores often heal well. […] The main goals of treatment are to relieve pressure on the sores, clean and dress the wounds appropriately, control infection, and provide adequate nutrition. […] Sometimes surgery is needed to close large wounds. […] To relieve pressure on the skin, people require careful positioning, protective devices, and support surfaces. […] Frequent repositioning (and selection of the proper position) is the main way to relieve pressure. […] To heal, pressure sores need to be cleaned, dead skin needs to be removed (a process called debridement), and dressings need to be applied.

• #2 Pressure Injuries (Pressure Ulcers) and Wound Care Treatment & Management: Approach Considerations, General Measures for Optimizing Medical Status, Pressure Reduction

  https://emedicine.medscape.com/article/190115-treatment

  Once a pressure injury (pressure ulcer) has developed, immediate treatment is required. Commonly used treatments over the years have included innovative mattresses, ointments, creams, solutions, dressings, ultrasonography (US), ultraviolet (UV) heat lamps, sugar, and surgery. In choosing a treatment strategy, consideration should be given to the stage of the wound and the purpose of the treatment (eg, protection, moisture, or removal of necrotic tissue). […] For stage 1 and 2 pressure injuries, wound care is usually conservative (ie, nonoperative). For stage 3 and 4 lesions, surgical intervention (eg, flap reconstruction) may be required, though some of these lesions must be treated conservatively because of coexisting medical problems. […] With thorough and comprehensive medical management, many pressure injuries may heal completely without the need for surgical intervention. Successful medical management of these injuries relies on the following key principles: Reduction of pressure, Adequate debridement of necrotic and devitalized tissue, Control of infection, Meticulous wound care.

• #2 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. […] Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. […] Debridement is indicated when necrotic tissue is present. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs. […] Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. […] Topical antibiotics should be considered if there is no improvement in healing after 14 days. Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection.

• #2 Treating Pressure Injuries: Cleaning and Dressing

  https://www.veteranshealthlibrary.va.gov/encyclopedia/142,84022_VA

  Negative pressure wound therapy […] Negative pressure wound therapy is also called vacuum-assisted closure. It gets rid of wound drainage, helps reduce bacterial growth, and promotes blood flow and healing. A foam, gauze, or transparent dressing is placed over the wound and then covered with a specialized dressing. Then tubing is attached to a pump, which creates a therapeutic negative pressure in the wound.

• #2 Bedsores (pressure ulcers) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-sores/diagnosis-treatment/drc-20355899

  Your healthcare professional likely will look closely at your skin to decide if you have a pressure ulcer. If a pressure ulcer is found, your healthcare professional will assign a stage to the wound. Staging helps determine what treatment is best for you. […] Treating pressure ulcers involves lowering pressure on the affected skin, caring for wounds, controlling pain, preventing infection and eating well. […] The first step in treating a bedsore is to lower the pressure and friction that caused it. […] Care for pressure ulcers depends on how deep the wound is. Generally, tending to a wound includes these steps: […] To heal properly, wounds need to be free of damaged, dead or infected tissue. The healthcare professional may remove damaged tissue, also known as debriding, by gently flushing the wound with water or cutting out damaged tissue. […] A large bedsore that fails to heal might require surgery. One method of surgical repair is to use padding from your muscle, skin or other tissue to cover the wound and cushion the affected bone. This is called flap surgery.

• #2 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  A trial of topical antibiotics, such as silver sulfadiazine cream (Silvadene), should be used for up to two weeks for clean ulcers that are not healing properly after two to four weeks of optimal wound care. […] Surgical consultation should be obtained for patients with clean stage III or IV ulcers that do not respond to optimal patient care or when quality of life would be improved with rapid wound closure. […] Growth factors (e.g., platelet-derived growth factor becaplermin [Regranex]) and vacuum-assisted closure for recalcitrant stage III and IV ulcers are emerging management options.

• #2 Pressure Sores – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/pressure-sores/pressure-sores

  Doctors usually try to treat pain with acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) rather than with opioids. […] Superficial infections can sometimes be treated with antibiotics that are applied directly to the skin. […] Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming. […] Deep or large pressure sores are difficult to treat. Sometimes they need to be closed with skin grafts and flaps with skin and sometimes muscle. […] The prognosis for early-stage pressure sores is excellent if people have received timely, appropriate treatment, but healing typically requires weeks. […] Prevention is the best strategy for dealing with pressure sores.

• #2 Pressure ulcers | informedhealth.org

  https://www.informedhealth.org/pressure-ulcers.html

  For stage 3 and 4 wounds, a technique called debridement is used as well to remove dead tissue. […] Proper wound care and the correct positioning can help to prevent pain or at least lessen it. If that isn’t enough, local anesthetics are an option. Wound dressings that contain painkillers may also be used. […] Oral medication like acetaminophen (paracetamol) or ibuprofen tablets can help relieve mild to moderate pain. Doctors can prescribe stronger painkillers if needed.

• #2 Pressure sores | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pressure-sores

  Anyone confined to a bed or chair for a long time is at risk of developing a pressure sore. […] Pressure sores can be difficult to treat. […] Treatment for pressure sores includes regular position changes, special mattresses and beds that reduce pressure, maintaining a healthy diet and nutrition, dressings to keep the sore moist and the surrounding skin dry, saline gauze dressing if other dressings are unavailable, light packing of any empty skin spaces with dressings to help prevent infection, regular cleaning with appropriate solutions, specific drugs and chemicals applied to the area if an infection persists, surgery to remove the damaged tissue, and operations to close the wound using skin grafts if necessary. […] Continuing supportive lifestyle habits such as eating a healthy and nutritious diet, as suggested by the nutritional staff.

• #2 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html/1000

  Surgical consultation should be obtained for patients with clean stage III or IV ulcers that do not respond to optimal patient care or when quality of life would be improved with rapid wound closure. […] Growth factors (e.g., platelet-derived growth factor becaplermin [Regranex]) and vacuum-assisted closure for recalcitrant stage III and IV ulcers are emerging management options.

• #2 Pressure Ulcers: Prevention, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1186.html

  The management of pressure ulcers is interdisciplinary, including primary care physicians, dermatologists, infectious disease consultants, social workers, psychologists, dietitians, podiatrists, home and wound-care nurses, rehabilitation professionals, and surgeons. […] The pressure-reducing devices used in preventive care also apply to treatment. […] Pain assessment should be completed, especially during repositioning, dressing changes, and debridement. […] Necrotic tissue promotes bacterial growth and impairs wound healing, and it should be debrided until eschar is removed and granulation tissue is present. […] Wounds should be cleansed initially and with each dressing change. […] Dressings that maintain a moist wound environment facilitate healing and can be used for autolytic debridement.

• #2 Pressure ulcer – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/378

  Pressure ulcers are a common problem in hospital inpatients and people who live in care facilities. […] Prevention is better than cure; all patients at risk of sustaining pressure damage should be assessed and provided with appropriate pressure-reducing strategies. Using support surfaces, repositioning the patient, optimising nutritional status, and moisturising sacral skin are appropriate strategies to prevent pressure ulcers. […] Management of pressure ulcers is determined by the location and condition or severity of the wound. Wounds should be managed in accordance with wound care practices or policies.

• #2 Pressure Ulcers | Bed Sores | MaineHealth

  https://www.mainehealth.org/care-services/wound-care-ostomy-care/pressure-ulcers-bed-sores

  Pressure ulcers are painful skin injuries due to long periods of pressure on the affected area. At MaineHealth, our expert team works to provide quality treatment for patients with pressure ulcers. […] Pressure ulcers commonly are found on the heels, lower back, ankles or elbows. They can be hard to treat and may lead to serious infections if not treated correctly. […] Treating pressure ulcers can be difficult. The most important step in healing is to make sure the sore does not get worse. […] Here are some things your healthcare provider might suggest that can help with healing: Take the pressure off the affected area. Use special padding under the area that is affected. Change position often. Eat a healthy diet with plenty of protein. Cover the sore with a clean bandage. Your doctor will tell you what type you will need. Keep the healthy area around the sore clean. Your doctor might tell you take antibiotic medicine. See a doctor or nurse about removing dead tissue around the wound.

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