What is the treatment for pressure ulcers?

From the Guidelines

Treatment for Pressure Ulcers

The most effective treatment for pressure ulcers involves a multifaceted approach that includes relieving pressure, keeping the wound clean, and promoting a healthy environment for healing 1.

Recommendations:

• Relieve Pressure: Turn the patient every 2 hours, use a pressure-redistributing mattress or cushion, and avoid direct pressure on the affected area 1.
• Clean the Wound: Clean the wound with saline solution and apply a topical antibiotic ointment, such as Neomycin or Bacitracin, to prevent infection 1.
• Cover the Wound: Cover the wound with a dressing, such as hydrocolloid or foam, to maintain a moist environment and protect the wound from further irritation 1.
• Manage Pain: Manage pain with acetaminophen (650mg every 4 hours) or ibuprofen (400mg every 4 hours) as needed 1.
• Consider Enzymatic Debridement: Consider using enzymatic debridement agents, such as collagenase (apply topically once daily), to remove dead tissue and promote healing 1.
• Apply Topical Growth Factors: Apply topical growth factors, such as platelet-derived growth factor (apply topically once daily), to enhance wound healing 1.
• Monitor for Infection: Monitor for signs of infection, such as increased redness, swelling, or purulent discharge, and seek medical attention if symptoms worsen or do not improve with treatment 1.

It's crucial to consult a healthcare professional for personalized guidance and to rule out any underlying conditions that may be contributing to the development of pressure ulcers 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Collagenase Santyl◊ Ointment should be applied once daily (or more frequently if the dressing becomes soiled, as from incontinence). When clinically indicated, crosshatching thick eschar with a #10 blade allows Collagenase Santyl◊ Ointment more surface contact with necrotic debris It is also desirable to remove, with forceps and scissors, as much loosened detritus as can be done readily Use Collagenase Santyl◊ Ointment in the following manner: 1 - Prior to application the wound should be cleansed of debris and digested material by gently rubbing with a gauze pad saturated with normal saline solution, or with the desired cleansing agent compatible with Collagenase Santyl◊ Ointment (See PRECAUTIONS ), followed by a normal saline solution rinse Use of Collagenase Santyl◊ Ointment should be terminated when debridement of necrotic tissue is complete and granulation tissue is well established.

The treatment for pressure ulcers involves:

• Debridement: using collagenase ointment to break down necrotic tissue
• Wound cleansing: with normal saline solution or a compatible cleansing agent
• Application of collagenase ointment: once daily, or more frequently if the dressing becomes soiled
• Removal of loosened detritus: with forceps and scissors
• Termination of treatment: when debridement is complete and granulation tissue is well established 2

From the Research

Treatment for Pressure Ulcers

The treatment for pressure ulcers involves a combination of measures to alleviate pressure, reduce risk factors, and promote wound healing. According to 3, pressure ulcers are graded on a scale from 0 to 4, based on the depth of wound penetration into underlying tissue. Superficial wounds are treated conservatively, while deeper pressure sores may require surgical treatment.

Conservative Wound Treatment

Conservative wound treatment may include the use of beds, overlays, and mattresses to reduce pressure on the affected area. Studies have shown that reactive air surfaces 4, 5 and alternating pressure air surfaces 4, 5 may be effective in promoting wound healing and reducing pressure ulcer incidence. However, the evidence is uncertain, and more research is needed to determine the relative effectiveness of different support surfaces.

Wound Cleansing

Wound cleansing is an important component of pressure ulcer care. Studies have investigated the effect of different wound cleansing solutions and techniques on wound healing. According to 6 and 7, there is no good trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. However, some studies have reported statistically significant improvements in wound healing with the use of saline spray containing Aloe vera, silver chloride, and decyl glucoside (Vulnopur) 6, 7 and pulsatile lavage 7.

Key Findings

• Pressure ulcers are graded on a scale from 0 to 4, based on the depth of wound penetration into underlying tissue 3.
• Conservative wound treatment may include the use of beds, overlays, and mattresses to reduce pressure on the affected area 4, 5.
• Reactive air surfaces and alternating pressure air surfaces may be effective in promoting wound healing and reducing pressure ulcer incidence 4, 5.
• There is no good trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers 6, 7.
• Some studies have reported statistically significant improvements in wound healing with the use of saline spray containing Aloe vera, silver chloride, and decyl glucoside (Vulnopur) 6, 7 and pulsatile lavage 7.

Some of the key treatment options for pressure ulcers include:

• Alleviation of pressure and reduction of risk factors 3
• Conservative wound treatment, such as the use of beds, overlays, and mattresses 4, 5
• Wound cleansing, although the evidence for specific solutions and techniques is uncertain 6, 7
• Surgical treatment for deeper pressure sores 3