Aetiology

• Pressure ulcers develop in patients who are unable to move parts of their body due to illness, paralysis or advancing age
• They typically develop over bony prominences such as the sacrum or heel
• The following factors predispose to the development of pressure ulcers:
  • Malnourishment
  • Incontinence: urinary and faecal
  • Lack of mobility
  • Pain (leads to a reduction in mobility)

Investigations

• The Waterlow score is widely used to screen for patients who are at risk of developing pressure areas
  • It includes a number of factors including body mass index, nutritional status, skin type, mobility and continence

Management

• A moist wound environment encourages ulcer healing
  • Hydrocolloid dressings and hydrogels may help facilitate this
  • The use of soap should be discouraged to avoid drying the wound
• Wound swabs should not be done routinely as the vast majority of pressure ulcers are colonised with bacteria
  • The decision to use systemic antibiotics should be taken on a clinical basis (e.g. evidence of surrounding cellulitis)
• Consider referral to the tissue viability nurse
• Surgical debridement may be beneficial for selected wounds