PRESSURE SORES

&
MANAGEMENT
PRESSURE SORES

 Also known as Pressure ulcers, Decubitus ulcers

or Bedsores, are localized injuries to the skin
and/or underlying tissue usually over a bony
prominence, as a result of pressure or pressure in
combination with shear and/or friction.
 Most commonly affected areas are the sacrum,
coccyx, heels & the hips, but other sites such as
the elbows, knees, ankles or the back of the
cranium can be affected.
 Completely treatable if found early, but without
medical attention bedsores can become life-
threatening.
 STAGES
 FOUR STAGES-
 Stage I
 Stage II
 Stage III
 Stage IV
 STAGE I
 Stage I - is the most superficial, indicated
by redness that does not subside after
pressure is relieved.
 The area may be painful, firm, soft,
warmer or cooler as compared to adjacent
tissue or perhaps be painful to the patient.
 Stage I may be difficult to detect in
individuals with dark skin tones.
 STAGE II
 Stage II -is damage to the epidermis
extending into, but no deeper than the
dermis with a red pink wound bed.
 In this stage, the ulcer may be referred to
as a blister or abrasion.
 This stage should not be used to describe
skin tears, tape burns, perineal dermatitis.
 STAGE III
 Stage III - involves the full thickness of the
skin, extending into, but not through the
subcutaneous tissue layer.
 This layer has a relatively poor blood supply
and can be difficult to heal.
 At this stage, Subcutaneous fat may be
visible but bone, tendon or muscle are not
exposed there may be undermining damage
that makes the wound much larger than it
may seem on the surface.
 STAGE IV
 Stage IV-Full thickness tissue loss with
exposed bone, tendon or muscle and is
the deepest.
 Ulcers can extend into muscle and/or
supporting structures (e.g., fascia, tendon
or joint capsule) Exposed bone/tendon is
visible or directly palpable.
COMMON SITES OF INVOLVEMENT
 ETIOLOGY
 Pressure ulcers are accepted to be caused by three
different tissue forces:
 Pressure, or
 Compression of tissues and/or
 Destruction of muscle cells
 The cause of pressure ulcers is pressure applied to
soft tissue so that blood flow to the soft tissue is
completely or partially obstructed. Shear is also a
cause: shear pulls on blood vessels that feed the
skin(single decubitus position).
 e.g. Prolonged bed ridden, spinal cord injuries who
are poorly mobilized, geriatric patients, confined to
wheelchairs, etc
ETIOLOGY Cont….

•Protein-calorie malnutrition,
•Microclimate (skin wetness caused by
sweating or incontinence).
•Diseases such as arteriosclerosis.
•Diseases that reduce the sensation / feeling in
the skin, such as paralysis or neuropathy.
•Temperature is also a very important factor.
•Moisture on the skin.
PATHOPHYSIOLOGY
 May be caused by inadequate perfusion
 Results in ischemia
 Leading to tissue necrosis or damage & cell
death
 If untreated wound may be infected.

Determining Risk
 By using the Braden Scale for Predicting
Pressure Ulcer Risk. The scale contains 6
areas of risk, sensory perception, immobility,
inactivity, moisture, nutrition, friction/shear.
 PREVENTION
 Turning the patient every 2 hours day & night
 Using special mattress
-Water bed
-Ripple mattress-alters pressure continuously
-Net bed
-Air fluidized bed- air pumped through sand medium
-Low air loss bed- air filled with different pressures
-Sheepskins – not suitable for incontinence
-Roho cushion
 Physiotherapy – UST, UVR/IRR, LASER, Ice
massage, passive movements, friction massage,
stretching, strengthening.
Air fluidizer Roho cusion

Ripple mattress Maggot

MEDICAL MANAGEMENT

 Autolytic debridement- moist dressing

 Biological debridement- maggot therapy
 Chemical debridement, or enzymatic
debridement, is the use of prescribed enzymes
that promote the removal of necrotic tissue.
 Mechanical debridement is the use of outside
force to remove dead tissue.
 Surgical debridement is the most popular
method, as it allows a surgeon to quickly
remove dead tissue with little pain to the
patient.
Physiotherapy
 Proper comfortable positioning (Frequent)
 Icing (ice massage)
 Passive movements
 Massage and Friction
 Stretching And Strengthening
 UVR, IRR
 LASER
 Ultrasound to surrounds
 Treatment is Multidisciplinary