Review: Pathogenesis and Management of Pressure Ulcers

Abstract

Pressure ulcers are a major problem in spinal cord injury patients and nursing home patients. The etiology is most probably pressure-induced ischemia. The first histopathologic changes are likely to occur either in muscle or subepidermally. Prevention of the problem is the best management, and the hallmark of prevention is identifying patients at risk and turning them frequently. When pressure sores occur, they heal with conservative measurements 80% of the time. With large, ulcerated, or infected lesions, surgical management is indicated. With sepsis, surgery should be performed immediately. Surgeons have made great progress filling huge defects with innovative grafts. Nevertheless, recurrence is a continuous problem. The use of an air-fluidized bed is beneficial in relieving pressure on the operated area during the postoperative period and in the measurement of pressure sores in general. Key Words: Pressure ulcers—Spinal cord injuryPressure-Shearing forces-Friction-Moisture.Areas of damage to the skin and tissues due to combined pressure, referred to as pressure sores, pressure ulcers, decubitus ulcers, and bed sores, continue to be a significant problem in the care of paralyzed and geriatric patients. The term &dquo;decubitus,&dquo; derived from the Latin decumbere (to lie down), is restrictive and inaccurate in that it implies that the ulcer is produced only when the patient is lying down. Although ulcers will develop over regions with bony prominences (e.g., trochanter, sacrum, heel, back, and occiput), the term decubitus excludes ulcers that can result from a combination of shear and pressure as may be seen over the ischial tuberosity of spinal cord injury (SCI) patients when seated. The term pressure ulcer is a more accurate phrase, since it describes directly the primary pathophysiologic mechanism underlying such wounds-the application of unrelieved pressure depriving the tissue of blood. A review of this topic is most timely in view of the everincreasing age of the population and the use of lifesupport technology to prolong the life of severely ill patients that constantly expose the practicing physician to the management of pressure sores (1-5). EpidemiologyPressure ulcers are a relatively common occurrence in SCI patients or patients in general who are immobilized. In ~ SCI patients, pressure ulcers over the ischial tuberosity have been shown to occur in 5-8% of patients per year (6); 25-85% of such patients have an ulcer at some time (7), and death due to complications arising from pressure ulcers occurs in 7-8% of these patients (8). These lesions are also a problem in a general hospital population. A recent survey by Allman (9) et al. showed almost 5% of patients (excluding obstetrical, ophthalmic, and psychiatric patients) had pressure ulcers, whereas an additional 12.3% were found to be at risk of developing ulcers. In general, up to 5% of patients in a general hospital population develop pressure ulcers (10,11).

Evaluating self-reported pressure ulcer prevention measures in persons with spinal cord injury using the revised Skin Management Needs Assessment Checklist: reliability study

“…2,3 Several of these factors cannot benefit from a targeted prevention. However, physical medicine and rehabilitation (PM&R) professionals can and must have an impact on some of these factors, right from the initial acute phase, such as behavioral factors, by educating patients on skin lesion prevention.…”