Paper 1 Citation: Levi B, Rees R.
 

Diagnosis and management of pressure ulcers

Clin Plas Surg. 2007;34:735-748.

Abstract:

Pressure ulcers present a clinical challenge in patients who are hospitalized and bed bound. High-risk groups, such as the elderly with limited mobility and patients with spinal cord injury, are significantly more likely to experience pressure wounds (one-third to two-thirds incidence and up to two thirds prevalence). Most pressure ulcers occur in the lower part of the body and 70% of pressure ulcers may occur in elderly patients. Overall prevalence has been estimated at 15%-29% in acute, long-term, and home care settings. Incidence appears to have the widest and highest range in acute care and the lowest range in home care.[1] Care costs for pressure ulcers and their complications are high with varying estimates ranging from $2.2 billion per year and higher.[2]

Several guidelines for prevention and treatment of pressure ulcers have been written. In 1992 and 1994, guidelines were written through the Agency for Health Care Policy and Research (AHCPR) to assist clinicians in the prevention and management of pressure ulcers. These guidelines highlight the importance of patient education and involvement in wound care planning. Algorithms for assessment, managing tissue loads, ulcer care, managing infection and bacterial colonization, surgical care, education and quality improvement are described. Assessment criteria for pressure ulcers included physical health and complications, nutritional parameters, pain, and psychological issues. Under the heading of ulcer care, an algorithm described treatment recommendations, including the debridement of the wound, wound cleansing, and adjunctive therapies such as electrical stimulation, hyperbaric oxygen, topical agents, and systemic drugs. Surgical closure, including direct skin closure, skin grafting, skin flaps, musculocutaneous flaps, and free flaps were discussed along with postoperative strategies to prevent complications and recurrence. Since that time, several guidelines and recommendations have been developed for the prevention and management of pressure ulcers, including the Wound, Ostomy, and Continence Nurses Society (WOCN) guideline for the prevention and management of pressure ulcers.[3] This article provided a basic review of pressure wounds and clinical care options.  

Key words:
Pressure ulcer, ischemia, surgical intervention, Stage III pressure ulcer, Stage IV pressure ulcer