Pressure ulcers: prenvention and guidelines

Pressure ulcers: prevention, guidelines and managementPressure ulcer are also known as bed sores, decubitus ulcers, or trophic ulcers. These are ischemic necrosis and ulceration of tissues over lying a bony prominence that has been subjected to prolonged pressureaainst an external object. Pressure sores occur most often in a patient with diminished or absent sensation or who are debilitated, emaciated, paralyzed or have been bedridden for a long periods of time. Tissues over the sacrum, Ischia, greater trochanters, and heels are specially susceptible. In some cases pressure sores have nown to have an effect on muscle and bone tissue too. Prophylaxis and prevention of pressure ulcers: The best treatment for any disease or condition is prevention of the condition in first place. This is achieved by relieving pressure on sensitive areas. In a bedridden patient, position must be changed atleast every 2 hrs until tolerance for longer periods can be demonstrated . Air filled alternating pressure mattresses sponge rubber eggrcrate mattresses, and silicone gel or water mattresses help decrease pressure on sensitive areas, but do not negate the need for position change every 2 hrs. when maximal release of pressure is needed, other systems including air floatation mattresses must be used. Wheelchair bound patients may develop pressure sores too. Thus they must shift position or be shifted every 10 to 15 minutes even if a pressure relieving cushion is used. Inspection under adequate light is extremely important. Pressure points should be checed for erythema or trauma at least once a day. Patients and families must be taught a routine of daily visual inspection and plapation of sites for potential ulcer formation. Meticulous care is important in the prevention of maceration and secondary infection. Lying on a sheepskin helps keep the patients skin in good condition and minimize pressure sores. Protective padding, pillows or a sheep sin can be used to separate body surfaces. Maintaining cleanliness and dryness avoids any eventual maceration. Bedding and clothing should be changed frequently , sheets should be soft , clean and free from any particulate matter. A well balanced diet high in protein is important. There is evidence to support that additional vitamin c and zinc help in the healing process.Management and treatment the ulcer is an analogous to an ice berg it has a small visible surface area with a more extensive unknown base . Incipient sores should be given all prophylactic measures and free from pressure and completely dry. Gentle massage accelerates healing. Stage 3 ulcers may heal spontaneously if the pressure is removed and the area is small. Hydrophilic gells and hydrocolloid dressings also speed healing. Stage 4 ulcers require extensive debridment and suregery. Cleansing with 1.5% hydrogen peroxide and whirlpool baths may assist in the process. Many new dressings and topical gels are becoming available, no one can definitively say that one is better than the other but they have been effective. Once in advanced stage a geriatric specialist or plastic surgery consults must be made to evaluate the correct course of treatment.