Managing pressure sores

Management of pressure ulcers accounts for a significant proportion of healthcare resources. Pressure ulcers (or sores) are caused by pressure-induced necrosis of soft tissue and as such should be entirely preventable. Although pressure can be considered as the initiating insult, multiple factors also contribute to progression and development. Prevention and treatment of pressure ulcers requires a multidisciplinary approach. Recognition of at-risk patients and the introduction of preventative measures is the mainstay of prevention. Multiple adjuncts to pressure ulcer resolution such as pressure relief systems, nutritional supplementation, pharmaceutical debridement, antimicrobials, negative wound pressure therapy and surgery can be employed. Category I and II ulcers are treated conservatively with dressings and the removal of precipitating factors. Although the majority of pressure ulcers are managed by nursing staff without any medical intervention, deeper lesions with significant tissue necrosis and secondary infection may require surgical debridement and possibly reconstructive closure. The development of a pressure ulcer is often a reflection of significant comorbidity and treatment should be applied in the context of the patient's overall likely clinical outcome and prognosis.