Treatment for Bed Ulcers (Pressure Ulcers)
Use hydrocolloid or foam dressings as first-line local wound care, combined with protein or amino acid supplementation, and consider electrical stimulation as adjunctive therapy to accelerate healing. 1
Core Treatment Algorithm
Local Wound Management
Dressing Selection:
- Apply hydrocolloid or foam dressings as the primary wound covering to reduce wound size and promote healing 1, 2
- Hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence) 1, 2
- Hydrocolloid and foam dressings perform equivalently for complete wound healing (moderate-quality evidence) 1, 2
- Avoid dextranomer paste, which is inferior to other dressings 1, 2
Common adverse effects of dressings include skin irritation, inflammation, tissue damage, and maceration, though evidence is insufficient to determine which specific dressings cause fewer harms 1
Nutritional Support
Protein/Amino Acid Supplementation:
- Provide protein or amino acid supplementation to all patients with pressure ulcers to reduce wound size 1, 2
- This recommendation applies particularly to patients with nutritional deficiencies 1
- Evidence may not generalize to well-nourished patients 1
Avoid vitamin C supplementation alone, as it has not shown benefit compared to placebo 1, 2
Adjunctive Therapies
Electrical Stimulation:
- Use electrical stimulation as adjunctive therapy in addition to standard treatment for stage 2-4 ulcers to accelerate wound healing 1, 2
- This has moderate-quality evidence for accelerating healing rate 1
- Exercise caution in frail elderly patients, who are more susceptible to adverse events including skin irritation 1, 2
- Electrical stimulation is similarly effective in hospital and rehabilitation settings 1
Other Adjunctive Therapies:
- Light therapy may reduce ulcer size but is equivalent to sham treatment for complete healing 1
- Insufficient evidence exists for electromagnetic therapy, therapeutic ultrasound, negative-pressure wound therapy, and laser therapy 1
Pressure Redistribution
Support Surface Selection:
- Use alternative foam mattresses rather than standard hospital mattresses (69% relative risk reduction in ulcer incidence) 3
- Air-fluidized beds reduce pressure ulcer size compared to other surfaces (moderate-quality evidence) 1
- Avoid expensive advanced support surfaces (alternating-air and low-air-loss beds) due to limited evidence, poorly reported harms, and unnecessary costs 1
Advanced Therapies for Severe Ulcers
Platelet-Derived Growth Factor (PDGF):
- PDGF-containing dressings improve healing in more severe ulcers compared to placebo 1
- However, use hydrocolloid or foam dressings instead as they are effective and cost significantly less than PDGF dressings 1
Surgical Intervention:
- Consider surgery for advanced-stage pressure ulcers 1, 2
- Sacral ulcers have lower recurrence rates after surgery compared to ischial ulcers 1, 2
- Dehiscence is more common when bone is removed and in patients with ischial ulcers 1, 2
- Patients with spinal cord injury have higher recurrence rates after surgical flap closure 1, 2
Stage-Specific Approach
For Stage I-II Ulcers:
- Apply hydrocolloid or foam dressings 2, 3
- Initiate protein or amino acid supplementation 2, 3
- Ensure proper pressure redistribution and repositioning 3
For Stage III-IV Ulcers:
- Perform debridement when necrotic tissue is present 4
- Apply hydrocolloid or foam dressings after debridement 2
- Consider PDGF for severe ulcers if cost is not prohibitive 2
- Evaluate for surgical intervention 2
Critical Pitfalls to Avoid
Do not use:
- Standard gauze dressings as primary treatment (inferior to hydrocolloid) 1, 2
- Vitamin C supplementation alone (no proven benefit) 1, 2
- Expensive advanced support surfaces without clear indication 1
- Dextranomer paste (inferior outcomes) 1, 2
Important Limitations: