What is the treatment for a sacral pressure (decubitus) ulcer?

From the Guidelines

The treatment of sacral decubitus ulcers requires a comprehensive approach focusing on pressure relief, wound care, infection management, and nutritional support. This approach is based on the most recent and highest quality study available, which emphasizes the importance of a multifaceted treatment plan 1.

Key Components of Treatment

• Pressure relief: using specialized support surfaces like air-fluidized beds, alternating pressure mattresses, or foam cushions, with patient repositioning every 2 hours 1
• Wound care: gentle cleansing with normal saline or wound cleansers, followed by appropriate dressing selection based on wound characteristics—hydrocolloids for shallow ulcers, alginates or foams for exudative wounds, and hydrogels for dry wounds 1
• Infection management: topical antimicrobials like silver-containing dressings for colonized wounds and systemic antibiotics for overt infection, guided by wound culture results 1
• Nutritional support: with 30-35 kcal/kg/day, 1.2-1.5 g/kg/day of protein, and adequate hydration, which is crucial for healing 1

Adjunctive Therapies

• Negative pressure wound therapy at 125 mmHg continuous pressure may accelerate healing for advanced ulcers (Stage III or IV) 1
• Surgical intervention with flap procedures may be necessary for large, non-healing ulcers 1
• Electrical stimulation can accelerate wound healing, but its use should be cautious, especially in frail elderly patients who are more susceptible to adverse events associated with this treatment 1

Considerations

• Patient characteristics, such as age and underlying health conditions, should be taken into account when selecting treatment options 1
• The potential harms and benefits of each treatment option should be carefully considered, with a focus on minimizing adverse events and promoting optimal healing outcomes 1

From the Research

Treatment Options for Sacral Pressure Ulcers

The treatment for sacral pressure (decubitus) ulcers can vary depending on the severity of the ulcer. Some treatment options include:

• Space filling through muscle flap and closed irrigation, as seen in a study published in 2014 2
• Negative pressure wound therapy with instillation and dwelling (NPWTi-d), which was used to treat a severe sacral osteomyelitis and sepsis with pressure ulcer infection in a case report from 2022 3
• Anterior flap hip disarticulation and myocutaneous gastrocnemius fillet flap in-continuity, a novel procedure used to treat a massive stage IV sacral decubitus ulcer in a case report from 2010 4
• Negative pressure therapy, which was used to treat stage IV pressure ulcers in a case report from 1999 5

Surgical Interventions

Surgical interventions may be necessary for severe sacral decubitus ulcers. These can include:

• Debridement of the decubitus ulcer, as performed in a study published in 2014 2
• Elevation of muscle flaps to cover the ischial tuberosity, as seen in a study published in 2014 2
• Hip disarticulation, which was performed in a case report from 2010 4

Wound Care and Management

Proper wound care and management are crucial for the treatment of sacral pressure ulcers. This can include:

• Regular dressing changes, as performed in a case report from 1999 5
• Use of negative pressure devices, such as the V.A.C. device, to promote wound healing 3, 5
• Irrigation debridement, which was used to treat a severe sacral osteomyelitis and sepsis with pressure ulcer infection in a case report from 2022 3