What are the management and treatment options for pressure ulcers?

Management and Treatment Options for Pressure Ulcers

The primary treatment for pressure ulcers should include protein or amino acid supplementation, hydrocolloid or foam dressings, and electrical stimulation as adjunctive therapy, along with pressure redistribution and proper wound care. 1

Core Treatment Strategies

Pressure Redistribution

• Use specialized support surfaces based on patient needs and risk assessment to reduce pressure on affected areas 2
• Air-fluidized beds have shown moderate-quality evidence for reducing pressure ulcer size compared to other surfaces 1
• Implement complete pressure offloading from the affected area to minimize trauma to the ulcer site 3
• Avoid using advanced support surfaces like alternating-air and low-air-loss beds without clear indication, as evidence is limited and they add unnecessary costs 2, 3

Wound Care

• Clean the wound regularly with water or saline to remove debris and create an optimal healing environment 3
• Perform regular debridement to remove necrotic tissue, which is necessary for proper wound healing 3
• Surgical debridement is particularly important for infected pressure ulcers 3
• Control exudate to maintain a moist wound environment 3

Dressings

• Use hydrocolloid or foam dressings to reduce wound size and promote healing (weak recommendation, low-quality evidence) 1, 2
• Low-quality evidence shows that hydrocolloid dressings are superior to gauze dressings for reducing ulcer size 1, 2
• Moderate-quality evidence indicates hydrocolloid dressings have similar complete wound healing outcomes compared to foam dressings 2

Nutritional Support

• Provide protein or amino acid supplementation to reduce wound size (weak recommendation, low-quality evidence) 1, 2
• Moderate-quality evidence shows that protein-containing supplements improve wound healing 1
• Vitamin C supplementation alone has not shown benefit compared to placebo (low-quality evidence) 1, 2

Adjunctive Therapies

Electrical Stimulation

• Use electrical stimulation as adjunctive therapy to accelerate wound healing (weak recommendation, moderate-quality evidence) 1, 2
• Moderate-quality evidence shows that electrical stimulation accelerates wound healing as an adjunctive therapy 1, 3
• Be cautious when using electrical stimulation in frail elderly patients, who may be more susceptible to adverse events 2

Other Adjunctive Therapies

• Low-quality evidence showed no difference or mixed findings for electromagnetic therapy, therapeutic ultrasound, negative-pressure wound therapy, light therapy, and laser therapy 1
• Topical negative pressure therapy may hasten healing of post-operative wounds, but effectiveness remains to be established 3
• Low-quality evidence showed that platelet-derived growth factor (PDGF) improved wound healing 1

Infection Management

• Assess for signs of infection such as increasing pain, erythema, warmth, or purulent drainage 3
• For infected pressure ulcers, use antibiotic therapy directed against both Gram-positive and Gram-negative facultative organisms as well as anaerobes 3
• Consider local antimicrobial therapy for superficial infections and systemic antibiotics for deeper or more severe infections 3

Special Considerations

• Patients with sacral pressure ulcers have lower recurrence rates after treatment compared to those with ischial pressure ulcers (low-quality evidence) 1, 2
• Patients with spinal cord injury may have a higher rate of recurrent pressure ulcers after surgical closure (low-quality evidence) 1, 3
• If the pressure ulcer is not showing signs of healing within 6 weeks despite optimal management, evaluate for vascular compromise 3
• Develop a prevention plan once the ulcer is healed to avoid recurrence 3, 4

Common Pitfalls and Caveats

• Do not rely solely on intermediate outcomes like reduction in wound size, as the relationship between reduction in wound size and eventual complete healing is not well-defined 2, 3
• Be aware that dehiscence is a common complication following surgical repair of pressure ulcers, especially when bone is removed or with ischial ulcers 3
• Prevention remains the most important aspect of pressure ulcer management, with an estimated 95% of all pressure ulcers being preventable 5
• The progression of pressure ulcers can be controlled if necessary care and treatment are provided in the early period 4