What is the treatment for pressure ulcers?

Treatment of Pressure Ulcers

The optimal treatment for pressure ulcers 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

Multidisciplinary Approach

• Treatment of pressure ulcers requires a multidisciplinary approach involving nurses, physicians, dietitians, and physical therapists to address the multiple factors contributing to ulcer development and impaired healing 2
• Treatment interventions should focus on alleviating conditions contributing to ulcer development, protecting the wound from contamination, and promoting tissue healing 1

Support Surfaces and Pressure Redistribution

• Air-fluidized beds are superior to standard hospital beds for reducing pressure ulcer size (moderate-quality evidence) 1
• Alternative foam mattresses provide a 69% reduction in relative risk of pressure ulcer incidence compared to standard hospital mattresses 3
• Alternating-air beds and low-air-loss mattresses have not shown substantial differences from other surfaces for reducing wound size 1

Wound Dressings

• Hydrocolloid or foam dressings are recommended to reduce wound size (weak recommendation, low-quality evidence) 2
• Hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence) 1
• Hydrocolloid dressings are equivalent to foam dressings for complete wound healing (moderate-quality evidence) 1
• The most common adverse effects of dressings include skin irritation, inflammation, tissue damage, and maceration 4

Nutritional Support

• Protein or amino acid supplementation is recommended to reduce wound size and improve healing rates (weak recommendation, low-quality evidence) 2, 1
• Vitamin C supplementation alone has not shown benefits compared to placebo 1
• For patients requiring tube feeding, high-protein formulations (25% of energy as protein) show greater reduction in ulcer area compared to standard formulations 5

Adjunctive Therapies

• Electrical stimulation is recommended as adjunctive therapy to accelerate wound healing (weak recommendation, moderate-quality evidence) 2, 1
• Caution should be exercised when using electrical stimulation in frail elderly patients who are more susceptible to adverse events, particularly skin irritation 1, 4
• Evidence for other adjunctive therapies such as electromagnetic therapy, laser therapy, ultrasound therapy, and negative pressure therapy is insufficient to establish efficacy 5

Surgical Management

• Surgery is considered an option for advanced-stage pressure ulcers (stages III and IV) that fail to respond to conservative management 1, 6
• Dehiscence is a common complication, occurring more frequently when bone is removed during surgery and in patients with ischial ulcers 1
• Patients with sacral pressure ulcers have lower recurrence rates after surgical repair compared to those with ischial ulcers 4

Stage-Specific Treatment Approach

Stage I and II Pressure Ulcers

• Apply hydrocolloid or foam dressings 2, 3
• Implement pressure redistribution with appropriate support surfaces 1, 3
• Initiate protein or amino acid supplementation 2, 4
• Ensure proper repositioning to relieve pressure 3

Stage III and IV Pressure Ulcers

• Consider debridement to remove necrotic tissue 5
• Use hydrocolloid or foam dressings, with consideration of alginate dressings for highly exudative wounds 5
• For deeper ulcers, combining alginate with hydrocolloid dressings results in significantly greater reduction in ulcer size compared to hydrocolloid alone 5
• Consider electrical stimulation as adjunctive therapy 2, 1
• Evaluate for surgical intervention if conservative measures fail 6

Special Considerations

• Patients with spinal cord injury have higher rates of pressure ulcer recurrence after treatment, requiring more intensive preventive measures 7
• Elderly patients may require more comprehensive assessment and management due to multiple comorbidities affecting healing 8
• The relationship between reduction in wound size and eventual complete healing is not well-defined, necessitating ongoing assessment of treatment efficacy 1