What is the treatment for pressure ulcers (bed sores)?

Treatment of Bed Sores (Pressure Ulcers)

Use hydrocolloid or foam dressings combined with protein supplementation as the foundation of pressure ulcer treatment, with air-fluidized beds for severe cases and electrical stimulation as adjunctive therapy when standard treatments are insufficient. 1, 2

Core Treatment Algorithm

Stage I-II Ulcers (Early Stage)

• Apply hydrocolloid or foam dressings - these are superior to gauze dressings for reducing wound size and promoting healing 1, 3, 2
• Initiate protein or amino acid supplementation immediately to improve wound healing rates 1, 3, 2
• Use pressure redistribution surfaces (alternating air mattresses or foam alternatives to standard hospital mattresses) 2, 4

Stage III-IV Ulcers (Advanced Stage)

• Perform mechanical debridement of all nonviable tissue before applying dressings 5
• Apply hydrocolloid or foam dressings after debridement 1, 3
• Consider platelet-derived growth factor for severe ulcers that fail to respond to standard therapy 1, 3
• Use air-fluidized beds - these are superior to standard hospital beds for reducing pressure ulcer size 1, 2
• Add electrical stimulation as adjunctive therapy to accelerate healing (though not proven for complete healing) 1, 3, 2

Essential Treatment Components

Pressure Redistribution (Critical First Step)

• Air-fluidized beds provide the best outcomes for reducing ulcer size compared to other support surfaces 1, 2
• Alternative foam mattresses reduce pressure ulcer incidence by 69% compared to standard hospital mattresses 2
• Alternating-air beds and low-air-loss mattresses do not show substantial differences from other surfaces 1

Wound Dressings (Primary Local Treatment)

• Hydrocolloid dressings are the preferred choice - superior to gauze for reducing wound size and equivalent to foam dressings for complete healing 1, 3, 2
• Foam dressings are an acceptable alternative with equivalent efficacy to hydrocolloid 1, 3, 2
• Avoid dextranomer paste - it is inferior to other dressings 1, 3
• Avoid radiant heat dressings - they accelerate healing but don't improve complete wound healing compared to other options 1

Nutritional Support (Essential for All Patients)

• Supplement with protein or amino acids to reduce wound size and improve healing rates 1, 3, 2
• This recommendation applies specifically to patients with nutritional deficiencies, though most bed-bound patients with pressure ulcers fall into this category 1
• Do not use vitamin C supplementation alone - it shows no benefit compared to placebo 1, 3, 2

Adjunctive Therapies (For Refractory Cases)

• Electrical stimulation accelerates wound healing for stage 2-4 ulcers when added to standard treatment 1, 3, 2
• Light therapy reduces ulcer size but is equivalent to sham treatment for complete healing 1
• Electromagnetic therapy, negative-pressure wound therapy, therapeutic ultrasound, and laser therapy show no clear benefit over controls 1

Critical Pitfalls and Precautions

Electrical Stimulation Warnings

• Frail elderly patients are more susceptible to adverse events with electrical stimulation - use with caution in this population 1, 3, 2
• The most common adverse effect is skin irritation 1, 3

Dressing-Related Complications

• Skin irritation, inflammation, tissue damage, and maceration are the most common harms from various dressings 1, 3
• Monitor closely for these complications regardless of dressing type chosen 1

Surgical Considerations (Last Resort)

• Surgery is reserved for advanced-stage pressure ulcers that fail conservative management 1, 3, 2
• Dehiscence is common (12-24% reoperation rate due to recurrence or flap failure) 1
• Dehiscence risk increases when bone is removed during surgery 1, 3, 2
• Ischial ulcers have higher complication rates than sacral or trochanteric ulcers 1, 3, 2
• Patients with spinal cord injuries have higher recurrence rates after surgical closure 1, 3

Additional Management Principles

Wound Environment Management

• Establish a moist wound-healing environment 5
• Eliminate drainage and cellulitis 5
• Protect the wound from contamination 1, 5

Monitoring Requirements

• Assess skin daily in all patients with limited mobility 5
• Measure every wound objectively to track progress 5
• Recognize that every patient with limited mobility is at risk for sacral, ischial, trochanteric, or heel ulcers 5

Cost Considerations

• Reactive air surfaces may cost an additional 26 US dollars per ulcer-free day in the first year compared to foam surfaces 6
• Early treatment prevents progression to stage IV ulcers, which have substantially higher treatment costs and mortality 5
• Bed-bound patients with pressure ulcers are almost twice as likely to die as those without ulcers 5