Biologic mediators of pressure ulcers and healing were discussed. Growth factor, proteinase inhibitors, and proteinase may be present in varying levels during tissue damage and healing. In some cases, catabolic chemicals present in higher levels will cause the catabolism to outweigh anabolism and healing. This results in a chronic wound and delayed healing.

 

Management

Stage I and II truncal ulcers can be treated using methods to reduce pressure, such as repositioning, low air-loss mattresses, and silver sulfadiazine (in stage II). An emphasis is placed on prevention activities.

 

For Stages III and IV, a careful history and physical should be taken and individual risk factors should be identified. Interventions to reduce risk factors are followed by efforts to reduce pressure and moisture exposure. Controlling muscle spasms in patients with spinal cord injuries can also be important to reducing pressure. Coordination of care by multiple disciplines will be a key factor in assuring successful treatment and may include physical and occupational therapy, nutrition, pain, and other specialties.

 

During these stages, there is a potential for osteomyelitis, which can increase morbidity and mortality. The authors recommended evaluation through erythrocyte sedimentation rate (ESR) after assessment findings that indicate the possibility of bone involvement. Confirmation with bone biopsy can also help to identify the target bacteria.

 

The authors outline their recommendations for surgical procedures to remove affected bone tissue where it is possible. Debridement of tissues is an important part of the process to improve wound closure once bacterial load is decreased in infected wounds. Systemic antibiotics are used for at least six weeks. Referral to infectious disease specialists may be indicated. The authors recommended the preparation for wound closure after surgical intervention with growth factor products for a period of six weeks, followed by flap surgery if wound healing progresses. Complications of surgical intervention include bruising, swelling from serum accumulation in tissues, resplitting of wound along suture lines, recurrence of wounds, and infection. Recommended postoperative management included prevention of pressure on the wound bed for a period of three months to decrease risk of recurrence. After the wound exhibits progress in healing, preventive strategies that are used for stages I and II ulcers should be implemented.

 

Summary:

This article provided an overview of pressure wounds, including risk factors and clinical treatment options. An emphasis was placed on prevention of recurrence and support to improve healing after medical and surgical intervention.