Pressure Ulcers Case Study

Pressure ulcers (PUs) can be defined as superficial or deep lesions in the skin or soft tissue of ischemic etiology.1 Substantive data support tissue ischemia resulting from external pressure over the bony prominences exceeding the closing pressure of nutrient capillaries (32 mmHg) for a long time enough to result in lethal injury to the tissues as the cause of pressure sores.2 Other factors that have been found to contribute to the formation of pressure sores are friction (may breach the epidermis), shearing (causes tearing of blood vessels), moisture (causing maceration of the skin), local infection, edema, neurological conditions, and poor nutrition. 3

Pelvic region is the most predisposed topographic area of the human body to pressure ulcers in immobile patients.4 A study with 649 patients and 1,604 PUs demonstrated that the most affected region was the ischiatic, an area of high pressure among wheel-chair bound patients. Sacral and trochanteric ulcers are more common in bedridden ones. 5

We consider the proposed by the European Pressure Ulcer Advisory Panel in 2009 as the most relevant one.6 It classifies PUs according to the level of tissue destruction into four stages (Table 1). Pressure sores classified as stage I and II can be treated conservatively by using the optimal non-surgical ulcer treatment and by eliminating the local and general conditions that adversely affect healing. However, if stage III or IV pressure ulcers are present, the surgical management is normally required.