Managing pressure sores

Pressure ulcers are caused by pressure-induced necrosis of soft tissue and as such should be entirely preventable. However, management of pressure ulcers accounts for a significant utilization of healthcare resources. Although pressure can be considered as the initiating insult, multiple factors also contribute to progression and development. Therefore, treatment of pressure ulcers requires a multidisciplinary approach. Recognition of at-risk patients and the introduction of preventative measures is the mainstay of treatment. 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. Grade I and II ulcers are treated conservatively with dressings and the removal of precipitating factors. Deeper lesions with significant tissue necrosis and secondary infection may require surgical debridement and reconstructive closure. The development of a pressure ulcer is often a reflection of significant co-morbidity and treatment should be applied in the context of the overall likely clinical outcome and prognosis.