What are the treatment options for pressure ulcers?

Published: December 14, 2009  |  Source: medicalnewstoday.com
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Treating pressure ulcers is not easy. If it is an open wound it most likely will not heal rapidly; even when healing does take place it may be patchy because the skin and other tissues have already been damaged. A multidisciplinary approach is required to deal with the many aspects of wound care. According to the National Health Service (NHS), UK, the MDT (multidisciplinary team) may consist of:

  • A dietician
  • A gastroenterologist (a digestive system doctor specialist)
  • A neurosurgeon (a brain and nervous system specialist surgeon)
  • An orthopedic surgeon (a bone and joints specialist surgeon)
  • A physical therapist (UK: physiotherapist)
  • A plastic surgeon
  • A social worker
  • A urologist (a urinary system specialist doctor)
  • An incontinence advisor
  • Nurses

The majority of Stage I and Stage II pressure ulcers will heal within a few weeks just with conservative measures. However, Stages III and IV wounds may require surgery.

Step 1 in treating any sore, regardless of its stage, is to remove the pressure that is causing it. This can be done by:

  • The patient’s positions – the patient needs to be turned and repositioned regularly. If the individual is in a wheelchair this may mean changing positions every 15 minutes. A bedridden patient may require repositioning every couple of hours. Sheepskin or some type of padding over the wound may help reduce friction when the patient is repositioned.
  • Support surfaces – special beds, pads, cushions and mattresses may all help reduce pressure on a sore, as well as protect likely areas from further breakdown. The type of support used depends on the patient’s mobility, their build, as well as the severity of the ulcer. Pillows and rubber rings should be avoided to cushion a wheelchair – air-filled, water-filled or foam devices are better. Experts say that low-air-loss beds or air-fluidized beds are better.

The following non-surgical treatments for pressure ulcers are also possible:

  • Clean wound – the wound must be kept clean. If it is a Stage I wound, it may be gently washed with water and a mild soap. Open sores, on the other hand, need to be cleaned with a saline solution each time the dressing is changed. Hydrogen peroxide or iodine should be avoided.
  • Continence – this must be controlled as much as possible. The patient may be helped with lifestyle changes, behavioral programs, incontinence pads as well as certain medications.
  • Debridement – a wound does not heal well if dead or infected tissue is present. The dead or infected tissue needs to be removed.
    • Surgical debridement – the doctor uses a scalpel to remove dead tissue (other devices are possible).
    • Mechanical debridement – a high-pressure irrigation device removes devitalized tissue.
    • Autolytic debridement – the body’s own enzymes break down dead tissue.
    • Enzymatic debridement – topical debriding enzymes are applied.
    • Ultrasound – dead tissue is removed using low-frequency energy waves.
    • Laser – dead tissue is removed using focused light beams.
  • Maggot therapy (larvae therapy) – this is an alternative method of debridement. The maggots feed on dead and infected tissue, but do not touch healthy tissue. They also release substance that kill bacteria and encourage healing. The maggots are placed into the wound dressing and the area is covered with gauze. A few days later the dressing and the maggots are removed.
  • Dressings – these are key to protecting the wound and accelerating healing. The type of dressing used depends on the severity of the wound. Basically, the wound must be kept moist, while the surrounding tissue has to stay dry. A Stage I sore does not usually require covering. Stage II wounds are generally treated with hydrocolloids, or transparent semi-permeable dressings’ that hold the moisture in and accelerate skin cell growth. Special dressings may be used for weeping wounds, or those with surface debris. An antibiotic cream may be used for contaminated sores.
  • Hydrotherapy – the skin may be kept clean with whirlpool baths. They may also naturally remove dead or contaminated tissue.
  • Oral antibiotics – the patient may be given oral antibiotics if the pressure ulcers are infected.
  • Nutrition – wound healing may be enhanced if the patient eats properly. This includes adequate supplies of protein, vitamins and minerals (especially vitamin C and zinc), and enough calories.
  • Relief from muscle spasms – skeletal muscle relaxants that block nerve reflexes in the spine or in the muscle cells may alleviate spasticity.

Surgery Some bedsores may become so severe that surgical intervention is necessary, regardless of treatment received. Surgery aims to improve the appearance of the sore, clean it up, treat or prevent infection, reduce fluid loss, and lower the risk of subsequent cancer.

Typically, a pad of muscle, skin or other tissue from the patient’s own body is used to cover the wound and cushion the affected bone (flap reconstruction).