Pressure Sores

• What are pressure sores?

  Localised injuries to skin & underlying tissue due to prolonged pressure

  Typically over bony prominences (sacrum, coccyx, heels, hips)
• What are the RFs for pressure sores?

  Immobility & reduced ability to change positions

  Prolonged pressure on specific body areas (e.g. bedridden or wheelchair bound)

  Poor nutrition & hydration

  Increased age

  Chronic illnesses which impair healing (diabetes, peripheral vascular disease)

  Incontinence

  Reduced sensory perception
• What can be used to assess the risk of pressure ulcers?

  Waterlow score

  Based on mobility, skin condition, nutrition & incontinence
• Pathophys - Pressure sores

  External pressure > capillary closing pressure -> occlusion of blood vessels -> ischaemia -> deprivation of oxygen & nutrients -> cell death & necrosis

  Reperfusion = further damage (due to oxidative stress & inflammation)
• What are the stages of pressure sores?

  Non-blanchable erythema

  Partial thickness skin loss (epidermis/dermis)

  • shallow open ulcer w/red-pink wound bed w/o sloughing

  Full thickness skin loss

  • exposes SC fat but not muscle/bone
  • slough may be present

  Full thickness tissue loss with exposed bone, muscle or tendon

  • extensive destruction & necrosis extending to underlying structures
• Fill in the blanks

  A) non-blanchin

  B) partial thickness

  C) full thickness skin loss

  D) full thickness tissue loss

  
• What are the signs & symptoms of pressure sores?

  Skin changes (from erythema to skin breakdown & ulceration)

  Pain/discomfort at site

  Warth/coolness at site

  Swelling or hardening of surrounding tissue

  Open sores or wounds
• What are the Inx for pressure sores?

  Full Hx & examination

  Swabs (if suspect infection)

  Bloods (FBC, U&Es, LFTs, CRP)

  X-ray/MRI (assess underlying tissue involvement)

  Tissue biopsy (if suspect malignancy/vasculitis)
• What are the DDx of pressure sores?

  Diabetic ulcers

  Venous/arterial ulcers

  Vasculitis

  Malignant skin lesions
• What is the management of pressure sores?

  Prevention

  • regular repositioning every 2 hrs for bed-bound pts
  • maintain skin integrity
  • ensure adequate nutrition & hydration

  Pressure relief (repositioning, mattresses & cushions)

  Wound care

  Pain management

  Infection control

  Surgery (severe, e.g. flap reconstruction)