Topical Treatment for Buttocks Pressure Ulcers
Primary Recommendation
Use hydrocolloid or foam dressings as your first-line topical treatment for buttocks pressure ulcers. 1, 2, 3
Evidence-Based Treatment Algorithm
Step 1: Wound Preparation
- Clean the wound with normal saline or water to remove debris and create an optimal healing environment 2, 4
- Perform sharp debridement with a scalpel to remove necrotic tissue, which is essential for proper healing 2, 3
- Surgical debridement is particularly critical if infection is present 2
Step 2: Select Appropriate Dressing
First-Line Options:
- Hydrocolloid dressings are superior to gauze for reducing wound size and should be your primary choice 1, 3, 5
- Foam dressings are equally effective alternatives to hydrocolloid dressings 1, 3
- Change these dressings every 1-7 days based on exudate levels (typically every 1.5-3 days for moderate to heavy drainage, extending to 3-7 days as exudate decreases) 3
When Infection is Present:
- Apply topical antimicrobials including iodine preparations, medical-grade honey, or silver-containing dressings 3
- Use collagen matrix dressings to reduce protease activity and promote fibroblast proliferation 3
- However, be aware that povidone iodine may actually impair healing compared to non-antimicrobial dressings 3, 5
Step 3: Avoid These Topical Agents
Do not use:
- Dextranomer paste - inferior to other dressings 6
- Routine povidone iodine - may impair healing 3
- Topical antibiotics without clear infection - leads to inappropriate antibiotic use and resistance 3, 7
Critical Adjunctive Measures
Beyond topical creams, you must address these factors:
- Provide protein or amino acid supplementation to reduce wound size, especially in nutritionally deficient patients 1, 2, 6
- Implement complete pressure offloading from the buttocks area to minimize trauma 2, 3
- Consider electrical stimulation as adjunctive therapy to accelerate healing for stage 2-4 ulcers 1, 2, 3
Special Considerations for Buttocks Location
- Assess for signs of infection including increasing pain, erythema, warmth, or purulent drainage 2, 6
- Probe to bone if osteomyelitis is suspected, and obtain imaging (MRI, CT, or ultrasound) if positive 3
- For infected buttocks ulcers, use systemic antibiotics covering Gram-positive, Gram-negative facultative organisms, and anaerobes as these infections are typically polymicrobial 2, 6
Common Pitfalls to Avoid
- Do not use advanced support surfaces (alternating-air, low-air-loss beds) without clear indication - evidence is limited and they add unnecessary costs 1, 2
- Do not culture wounds without clinical signs of infection - this leads to inappropriate antibiotic use 3
- Do not rely on vitamin C supplementation - no benefit has been demonstrated 3, 6
- Do not use platelet-derived growth factor (PDGF) dressings routinely - they are expensive and only show benefit for ulcers >7 cm, while hydrocolloid/foam dressings are equally effective and cost less 1, 6