Pressure ulcer care

What it is

A pressure sore is an area of tissue necrosis caused by prolonged soft tissue compression, with local ischemia and moisture. It is a problem of the multimorbid and the elderly. Pressure sores sit at the pressure sites and are divided into 4 grades.

Causes and risk

Prolonged soft tissue compression is what causes the sore, so the sites are the ones that carry the body weight against a surface: back of head and ears, shoulder, elbow, hip, inner knees, heel, and the lower back and buttocks. A pressure sore is also listed among the general complications of a fracture, together with pneumonia, UTI and chest pain, next to the fracture-related ones such as compartment syndrome and DVT.

The ulcers it is set against

The page puts four ulcers side by side, and each is known by one point of its own:

• Pressure sore: at the pressure sites, divided into 4 grades
• Venous leg ulcer: common in the elderly, the result of chronic venous hypertension, with persistent inflammation, hemosiderin deposits and lipodermatosclerosis; it lies in the medial aspect of the foot above the medial malleolus, with ulcerating margins
• Arterial ulcer: reduced blood supply with ischemia and necrosis, little exudate, atrophic skin and pain; punched out, atrophic and associated with pain
• Diabetic foot ulcer: in the sites of pressure in the foot, with whitish material around it called callus, usually a combination of arterial and neuropathic ulcers; you need to know if it is infected, treatment includes dressing and debridement, and if complicated it may cause charcot's joint