What is the therapeutic regimen for managing pressure ulcers?

Therapeutic Regimen for Pressure Ulcers

The therapeutic regimen for pressure ulcers should include hydrocolloid or foam dressings, protein supplementation, pressure redistribution with specialized support surfaces, and electrical stimulation as adjunctive therapy in selected cases to reduce wound size and accelerate healing. 1, 2

Core Treatment Components

Wound Dressings (First-Line Therapy)

Apply hydrocolloid or foam dressings to all pressure ulcers to reduce wound size. 1, 2, 3

• Hydrocolloid dressings are superior to gauze dressings for reducing wound size, though the evidence quality is low 2, 3
• Hydrocolloid and foam dressings have equivalent efficacy for complete wound healing based on moderate-quality evidence 2, 3
• Avoid dextranomer paste as it is inferior to other dressings 2

Nutritional Support (Essential Component)

Provide protein or amino acid supplementation to all patients with pressure ulcers. 1, 2, 3

• This reduces wound size, though the recommendation is based on low-quality evidence 1, 2
• Vitamin C supplementation alone provides no benefit compared to placebo and should not be used as monotherapy 2, 3

Pressure Redistribution (Critical Foundation)

Use alternative foam mattresses rather than standard hospital mattresses for all patients. 2, 3

• Alternative foam mattresses provide a 69% relative risk reduction in pressure ulcer incidence 2, 3
• Air-fluidized beds are superior to other surfaces for reducing pressure ulcer size when resources permit 2
• Alternating air mattresses and low-air-loss mattresses do not substantially differ from other surfaces and add unnecessary costs unless specifically indicated 2, 3

Adjunctive Electrical Stimulation (Selected Cases)

Consider electrical stimulation as adjunctive therapy to accelerate wound healing, particularly in younger, more robust patients. 1, 2, 3

• This has moderate-quality evidence for accelerating healing, the strongest evidence grade among the recommendations 1, 2
• Critical caveat: Frail elderly patients are more susceptible to adverse events with electrical stimulation and should be approached cautiously 2, 3
• No evidence supports electrical stimulation for complete wound healing, only for acceleration 2

Advanced Interventions

Surgical Management (Advanced-Stage Ulcers)

Reserve surgery for advanced-stage pressure ulcers (Stage III-IV) that fail conservative management. 2, 4

• Dehiscence is more common when bone is removed and in patients with ischial ulcers 2
• Patients with sacral pressure ulcers have lower recurrence rates after surgery compared to ischial ulcers 2, 3
• Preoperative optimization includes vigorous wound care, optimal nutrition, spasticity control, and patient education 5

Negative Pressure Wound Therapy

Consider negative pressure wound therapy for Stage III and Stage IV pressure ulcers as part of the treatment algorithm 6

Multidisciplinary Coordination

The treatment approach requires coordination among nurses, physicians, dietitians, and physical therapists to address pressure relief, wound protection, nutritional optimization, and monitoring for complications including infection, sepsis, osteomyelitis, and fistulas 1, 7

Common Pitfalls to Avoid

• Do not use standard hospital mattresses when alternative foam mattresses are available—this represents a 69% increased risk 2, 3
• Do not rely on vitamin C supplementation alone for nutritional support 2, 3
• Do not use electrical stimulation indiscriminately in frail elderly patients without careful risk-benefit assessment 2, 3
• Do not assume wound size reduction guarantees complete healing—the relationship between these outcomes is not well-defined 3