What is the treatment for pressure ulcers (bedsores)?

Treatment of Pressure Ulcers (Bedsores)

Treat pressure ulcers with hydrocolloid or foam dressings, protein supplementation, and pressure redistribution using specialized support surfaces, with electrical stimulation as adjunctive therapy in selected cases. 1

Core Treatment Components

Wound Dressings (First-Line)

• Use hydrocolloid or foam dressings as primary wound coverage to reduce wound size and promote healing 1, 2
• Hydrocolloid dressings are superior to traditional gauze dressings for reducing wound size 1, 2
• Hydrocolloid and foam dressings are equivalent to each other for achieving complete wound healing 1, 2
• Avoid dextranomer paste, which is inferior to other dressings 1, 2
• Common adverse effects include skin irritation, inflammation, and tissue maceration, but these do not differ significantly between dressing types 1

Nutritional Support (Essential Component)

• Provide protein or amino acid supplementation to all patients with pressure ulcers to reduce wound size and improve healing rates 1, 2
• This recommendation applies even though the evidence quality is low, as nutritional supplementation has demonstrated improved wound healing rates 1
• Vitamin C supplementation alone has not shown benefits compared to placebo and should not be used as monotherapy 2

Pressure Redistribution (Critical Foundation)

• Use air-fluidized beds when available, as they are superior to standard hospital beds and other support surfaces for reducing pressure ulcer size 1, 2
• Alternative foam mattresses provide a 69% reduction in pressure ulcer incidence compared to standard hospital mattresses 2
• Alternating-air beds and low-air-loss mattresses do not substantially differ from other surfaces in effectiveness 1, 2

Adjunctive Therapies

Electrical Stimulation

• Consider electrical stimulation as adjunctive therapy to accelerate wound healing, particularly in younger, non-frail patients 1, 2
• This has moderate-quality evidence supporting its use for accelerating healing 1, 2
• Avoid or use with extreme caution in frail elderly patients, who experience more adverse events including skin irritation 1, 2
• Electrical stimulation produces similar results in hospital and rehabilitation settings 1

Debridement

• Collagenase ointment is FDA-approved for debriding chronic dermal ulcers and severely burned areas 3
• Debridement should be performed before applying advanced dressings for stage III and IV ulcers 4

Treatment Algorithm by Ulcer Stage

Stage I-II Ulcers

• Apply hydrocolloid or foam dressings 1, 2, 4
• Initiate protein or amino acid supplementation 1, 2, 4
• Ensure appropriate pressure redistribution surface 2

Stage III-IV Ulcers

• Perform debridement as needed 4, 3
• Apply hydrocolloid or foam dressings after debridement 4
• Provide protein or amino acid supplementation 4
• Consider platelet-derived growth factor for severe ulcers 1, 4
• Evaluate for surgical intervention if conservative measures fail 2, 4

Surgical Considerations

• Reserve surgery for advanced-stage pressure ulcers that fail conservative management 2, 4
• Dehiscence is the most common complication, occurring in 12-24% of cases 1
• Dehiscence risk increases when bone is removed during surgery 1, 2, 4
• Patients with ischial ulcers have higher complication rates than those with sacral or trochanteric ulcers 1, 2, 4
• Patients with sacral pressure ulcers have lower recurrence rates after surgery compared to ischial ulcers 2, 4
• Patients with spinal cord injuries have higher rates of recurrent pressure ulcers after surgical flap closure 1

Multidisciplinary Approach

• Treatment requires coordination among nurses, physicians, dietitians, and physical therapists 1, 2
• Address underlying conditions contributing to ulcer development (immobility, malnutrition, moisture) 1, 2

Common Pitfalls to Avoid

• Do not use gauze dressings as primary treatment—they are inferior to hydrocolloid and foam dressings 1, 2
• Do not rely on vitamin C supplementation alone—it has not demonstrated benefit 2
• Do not apply electrical stimulation to frail elderly patients without careful risk-benefit assessment 1, 2
• Do not neglect nutritional support—protein supplementation is a core component of treatment 1, 2