Pressure sores or decubitus ulcers, often termed bedsores, develop on points of the body subject to continuous pressure. Sustained pressure over these areas can restrict blood flow to the skin, fat, and muscle, which necrotizes or kills these tissues.
Pressure sores generally present in at-risk areas such as the back of head, ankles, heels, hips, and sacrum. The severity of tissue damage is broken down in four stages with Stage IV being the most severe and characterized as having full thickness tissue death. Given the severity of tissue necrosis for Stage IV wounds there usually is a high risk for bone infection.
Reducing pressure over at-risk body parts is essential for preventing pressure sores as well as enabling wounds to heal, but malnutrition will also adversely contribute to wound healing problems. Our recommendation is determining nutritional deficiencies and replete all nutrients, including protein, carbohydrates, fat, vitamins, and minerals.
Stage IV pressure sores usually benefit from at least a surgical debridement to reduce bioburden and risk of infection and allow the body to respond to an acute injury than an infected chronic wound.
In addition, Stage IV wounds tend to extend to bone and if this is the case a bone infection should be strongly considered. Consequently, obtaining a bone biopsy is recommended to assess for a bone infection and begin treatment promptly since these wounds will probably not heal without an extended antibiotic treatment. Surgical reconstruction of pressure sores can be discussed on a patient by patient basis, but the general goal is to mobilize adjacent, healthy tissue to provide adequate coverage over the wound. Surgery on a pressure sore is usually done in a staged manner and takes into account various parameters such as infection suppression, nutrition optimization, patient motivation and functional status.
Recovery from reconstruction of a pressure sore will usually involve bed rest for an extended period of time to allow fragile tissue to heal sufficiently to endure pressure without wound dehiscence. Once wounds are healed patients should work with Physical and Occupational Therapy to learn how to offload the reconstructed areas and prevent future pressure sores.
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