Pressure Ulcers Prevention & treatment

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Pressure sores (decubitus ulcers)

A pressure sore refers to聽skin or tissue damage that occurs when there is decrease blood circulation due to pressure in a specific area.

Initially, slight redness on the affected area can be noticed (the first sign of tissue damage). The tissue underneath perishes due to poor blood supply. Various skin layers,聽muscles and bones can be affected. Areas that are particularly at risk are聽the sacrum, heels, elbows and shoulder blades.

Pressure sores can be mostly avoided through preventive measures聽such as formal risk assesment and specific risk mitigation (pressure relief, preventive skin care) by minimizing risk factors.

Once a pressure sore has developed, it is important to draw up a聽coordinated treatment plan to induce healing and eliminate all聽the disruptive factors. The basic prerequisites for wound healing聽must be met. These include a clean wound, functioning circulation聽and adequate nutrition in terms of both calories and聽nutrients, along with adequate fluid intake. The latter is often聽a problem in elderly people (as a a basic rule, daily fluid intake聽should be 40 ml per kg of body weight).

Depending on the extent of tissue damage, pressure ulcers are categorized into four stages:

Stage 1聽
The skin is not broken, but the redness does not turn white when touched.

Stage 2
Damage involves the epidermis, dermis, or both. Clinically, the damage appears as an abrasion or blister. The surrounding skin may be reddened.

Stage 3
Damage extends through all the superficial layers of the skin, fat tissue, right to and including the muscle. The ulcer appears as a deep crater.

Stage 4
Damage includes destruction of all soft tissue structures and bone or joint structures.

Anyone can develop a pressure sore, but elderly, bed-ridden, paralyzed and malnourished patients are at higher risk.

Identifying individuals at risk of pressure ulcers and initiating preventive measures are vital steps in reducing pressure ulcer incidents. The individual risk of developing a pressure ulcer can be determined by using risk assessment tools such as the Braden Scale.

The Braden Scale is a rating scale made up of 6 sub-scales that asses:

  • Sensory / perception (ability to respond meaningfully to pressurerelated discomfort)聽
  • Moisture (degree to which the skin is exposed to moisture)
  • Activity (degree of physical activity)
  • Mobility (ability to change and control body position)
  • Nutrition (usual food intake pattern)
  • Friction and shear

The most important aspect in prevention and treatment of pressure sores is certainly pressure relief. This can be best achieved by frequent patient repositioning and mobilization, but also using adequate mattresses or specific pressure-reducing聽 equipment. Appropriate treatment should include thorough wound cleansing, avital tissue removal and a wound environment free of urine and feces. Stage 3 and 4 ulcers often require surgical debridement.

Pressure Ulcer Prevention & Management

Classification of ulcers based on EPUAP/NPUAP, 20111

Classification of ulcer: 1

  • Non-blanchable redness of intact聽skin usually over a bony prominence.
  • Discoloration of the skin, warmth, edema, hardness or pain compared to聽adjacent tissues may also be present.
Treatment goals:聽
  • Skin repair
    Restore capillary function
Local wound treatment:
  • Promote skin integrity by using hyper-oxgenated聽fatty acid-based products聽(e.g.聽Linovera庐1)
  • Prevent skin breakdown due to friction聽or shear using skin barrier products

Classification of ulcer:
2 - Non-infected聽

  • Partial thickness skin damage聽(blister)
  • Presents as a shiny or dry shallow ulcer without slough or bruising聽(bruising indicates deep tissue聽injury)聽
  • Check for skin maceration
Treatment goals:聽
  • Provide a clean wound bed for granulation tissue
Local wound treatment:

Classification of ulcer:
3 - Non-infected聽

  • Full-thickness tissue loss. Subcutaneous聽fat may be visible but bone,聽tendon or muscle are not exposed.
  • Slough may be present but does not聽obscure the depth of tissue loss.
Treatment goals:聽
  • Remove slough
  • Provide a clean wound bed for granulation tissue
Local wound treatment:

Classification of ulcer:
4 - Non-infected聽

  • Full-thickness tissue loss with聽bone, tendon or muscle visible.
  • Slough or eschar may be present.聽Often includes undermining and聽tunneling.
Treatment goals:聽
  • Remove slough
  • Provide a clean wound bed for granulation tissues
Local wound treatment:

Classification of ulcer:
2 - 4 - Infected聽

  • Signs and symptoms of聽infection, such as聽discoloration, swelling,聽heat and odor
Treatment goals:聽
  • Reduce bacterial load
  • Manage exudate/odor
  • Prevent/remove biofilm
  • Provide a clean wound bed for granulation tissue
Local wound treatment:


1. Recommended use as per guidelines EPUAP, 2012 see:

2. NOTE: As Stage IV PUs may involve exposed cartilage, special caution is required. Some products (e.g. Prontosan庐) are contraindicated for the use on hyaline cartilage. In all cases, a careful risk-benefit assessment should be

performed. Decisions on product use must lie with the attending physician and normal saline used instead of Prontosan庐 where indicated.

3. Use as secondary dressing an appropriate absorbent/low adherent moist dressing in flat or anatomical shape (e.g. Askina庐 Foam/Askina庐 Heel/Askina庐/Askina庐 DresSil Heel/Askina庐 DresSil Sacrum)

Related documents:

Description Document Link
Quick guide Pressure Ulcers.pdf
pdf (963.6 KB)