Pressure Ulcer Treatment

Introduction to Pressure Ulcer Management

• The American College of Physicians recommends that optimal pressure ulcer treatment should include hydrocolloid or foam dressings, protein supplementation, pressure redistribution, and in selected cases, adjuvant therapies such as electrical stimulation to reduce wound size and promote healing 1, 2

Multidisciplinary Approach

• A multidisciplinary approach to treating pressure ulcers is necessary, addressing factors such as alleviating conditions that contribute to ulcer development, protecting the wound from contamination, promoting tissue healing, and considering adjuvant therapies and possible surgical repair in advanced cases 4, 3

Support Surfaces and Pressure Redistribution

• Air-fluidized beds are superior to other surfaces for reducing pressure ulcer size (moderate-quality evidence) 2, 4
• Alternative foam mattresses provide a 69% reduction in relative risk of pressure ulcer incidence compared to standard hospital mattresses 3
• Alternating air mattresses and low-air-loss mattresses do not substantially differ from other surfaces in reducing wound size 4, 5

Dressings and Local Applications

• Hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence) 2, 4
• Hydrocolloid dressings are equivalent to foam dressings for complete wound healing (moderate-quality evidence) 4, 3
• Dextranomer paste is inferior to other dressings for reducing wound size 4

Nutritional Support

• Protein or amino acid supplementation is recommended to reduce wound size (weak recommendation, low-quality evidence) 4, 5
• Vitamin C supplementation alone has not shown benefits compared to placebo 4, 3

Adjuvant Therapies

• Electrical stimulation may accelerate wound healing compared to control, although there is no evidence it is superior for complete wound healing (moderate-quality evidence) 4, 3
• Caution: frail elderly patients are more susceptible to adverse events associated with electrical stimulation 4, 6

Surgical Considerations

• Surgery is considered an option for advanced-stage pressure ulcers 4, 6
• Dehiscence, a commonly reported adverse event, was more common when bone was removed and in patients with ischial ulcers 5, 6
• Patients with sacral pressure ulcers had a lower recurrence rate after surgery than those with ischial pressure ulcers 6