Pressure Sores (Article 7) - Treatment for Pressure Sores/Ulcers

Pressure Sores - Treatment for Pressure Sores/Ulcers

Treatment for pressure ulcers can vary, depending on the grade of the ulcer.

Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed.

Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team comprising different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT).

Your MDT may include:

• a tissue viability nurse (a nurse who specialises in wound care and prevention)

• a social worker

• a physiotherapist

• an occupational therapist

• a dietitian

• medical and surgical experts with experience in pressure ulcer management

Changing position

It's important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Moving and regularly changing your position helps to prevent pressure ulcers developing and relieves the pressure on the ulcers that have developed.

After your risk assessment is completed, your care team will draw up a "repositioning timetable", which states how often you need to be moved. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two hours.

The risk assessment will also consider the most effective way of avoiding putting any vulnerable areas of skin under pressure whenever possible.

You may also be given training and advice about:

• correct sitting and lying positions

• how you can adjust your sitting and lying position

• how often you need to move or be moved

• how best to support your feet

• how to maintain good posture

• the special equipment you should use and how to use it

Mattresses and cushions

There are a range of special mattresses and cushions that can relieve pressure on vulnerable parts of the body. Your care team will discuss the types of mattresses and cushions most suitable for you.

Those thought to be at risk of developing pressure ulcers, or who have pre-existing grade one or two pressure ulcers, usually benefit from a specially designed foam mattress, which relieves the pressure on their body.

People with a grade three or four pressure ulcer will require a more sophisticated mattress or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required.

Dressings

Specially designed dressings and bandages can be used to protect pressure ulcers and speed up the healing process. Examples of these types of dressings include:

• hydrocolloid dressings – these contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy area of skin dry 

• alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process

Creams and ointments

Topical preparations, such as creams and ointments, can be used to help speed up the healing process and prevent further tissue damage.

Antibiotics

If you have a pressure ulcer, you will not routinely be prescribed antibiotics. These are usually only prescribed to treat an infected pressure ulcer and prevent the infection from spreading. 

Antiseptic cream may also be applied directly to pressure ulcers to clear out any bacteria that may be present.

Nutrition

Certain dietary supplements, such as protein, zinc and vitamin C, have been shown to accelerate wound healing.

If your diet lacks these vitamins and minerals, your skin may be more vulnerable to developing pressure ulcers. As a result of this, you may be referred to a dietitian so that a suitable dietary plan can be drawn up for you.

Debridement

In some cases, it may be necessary to remove dead tissue from the ulcer to help stimulate the healing process. This procedure is known as debridement.

If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste. Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include:

• cleansing and pressure irrigation – where dead tissue is removed using high-pressure water jets

• ultrasound – dead tissue is removed using low-frequency energy waves

• laser – dead tissue is removed using focused beams of light

• surgical debridement – dead tissue is removed using surgical instruments, such as scalpels and forceps

• A local anaesthetic will be used to numb the area of skin and tissue around the ulcer so that debridement does not cause any pain or discomfort.

• Maggot therapy

Maggot therapy, also known as larvae therapy, is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help to fight infection by releasing substances that kill bacteria and stimulate the healing process.

During maggot therapy, the maggots are mixed into a wound dressing and the area is covered with gauze. After a few days, the dressing is taken off and the maggots are removed.

Many people may find the idea of maggot therapy off-putting, but research has found that it is often more effective than more traditional methods of debridement. 

Surgery

It's not always possible for a grade three or four pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring.

Surgical treatment involves cleaning the wound and closing it by bringing together the edges of the wound (direct closure), or by using tissue moved from a nearby part of the body (flap reconstruction).

Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health. There is a risk of a large number of possible complications occurring after surgery, including:

• infection

• tissue death of the implanted flap

• muscle weakness

• Blisters (small pockets of fluid that develop inside the skin)

• recurrence of the pressure ulcers

• blood poisoning

• infection of the bone

• internal bleeding

• Abscesses (painful collections of pus that develop inside the body)

• DVT (a blood clot that develops inside the veins of the leg)

• Despite the risks, surgery is often a necessity to prevent life-threatening complications, such as blood poisoning and gangrene (the decay or death of living tissue).