Pressure sores, also known as bedsores or decubitus ulcers, are areas of damaged skin and underlying tissue that develop when prolonged pressure is placed on certain areas of the body. They are most common on the ischium, greater trochanter, sacrum, heel, and malleolus. Risk factors include malnutrition, diabetes, peripheral vascular disease, altered mental status, and smoking. Pressure sores develop when prolonged pressure cuts off blood flow to the skin for over 30 minutes, causing tissue hypoxia and necrosis. They are staged from 1 to 4 based on severity of skin and tissue damage. Prevention through proper nutrition, skin care, pressure-relieving devices and frequent repositioning is important to

1. Pressure Sores
By
Vivek Ghosh
Intern
Dept. of General Surgery, GMCTH
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2. Introduction
• Defined as tissue necrosis with ulceration due
to prolonged pressure
• Aka Bedsores/ pressure ulcers/ decubitus
ulcers/ trophic ulcers
• Incidence: 5% of all hospitalized pts.
80% of paraplegic pts.
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3. Site: frequency in descending order
• Ischium
• Greater trochanter
• Sacrum
• Heel
• Malleolus ( lateral then medial)
• Occiput
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4. • Risk factors:
Malnutrition
 Diabetes mellitus
 Peripheral vascular disease
Cerebrovascular accidents
 Peripheral nerve injury
 Old age
 Smoking
 Altered mental status
 Urinary and fecal incontinence
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5. Pathogenesis
Prolonged pressure/friction/shear
Blood flow to skin ceases once external pressure more
than 30 mm Hg
Tissue hypoxia, necrosis,
Ulceration
Pressure sore
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6. Staging of Pressure sore (American National Pressure
Ulcer Advisory Panel)
1.Nonblanchable erythema without a breach in
the epidermis
2.Partial thickness skin loss involving the
epidermis and dermis
3.Full thickness skin loss extending into the
subcutaneous tissue but not through underlying
fascia
4. Full thickness skin loss through fascia with
extensive tissue destruction ,maybe involving
muscles ,bone , tendon or joint .
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7. Clinical features
• Stage 1: Skin appears red, may be
tender, painful, firm, soft, cool or warm
than surrounding
• Stage 2: Wound may be shallow and
pinkish or red, looks like fluid filled
blisters or ruptured blister
• Stage 3: Loss of skin, usually exposes
some fat, crater-like. Bottom of the
wound may have some yellowish dead
tissue
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8. • Stage 4: The wound may expose muscle, bone or
tendons. Bottom of the wound likely contains dead
tissue that is yellowish or dark and crusty. Damage
often extends beyond the primary wound below
layers of healthy skin.
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9. Investigations
• Study of discharge
• Blood sugar
• Biopsy from the edge
• X-ray of part ,X-ray of spine
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10. Management
Prevention is better than cure
Better nursing is the key to prevention
• Prevention :awareness –educating the patients and their
caregivers about the pressure relief
• Includes :
Good skin care
Pressure dispersing cushions or foams
Use of low air loss & air fluidised beds
Urinary or fecal diversion
Optimum nutrition
Bed bound pts.- turned atleast every 2hrly
Wheelchair bound pts.- lift off their seat for 10 secs. Every 10
mins
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11. Treatment
• Treatment of cause
• Nutritional support
• Rest, antibiotics, regular dressing
• For stage 1 and 2 pressure injuries, wound care is usually
conservative (ie, nonoperative)
• For stage 3 and 4 lesions, surgical intervention (eg, flap
reconstruction) may be required
• Preoperative management:
 Adequate debridement
 Vacuum assisted closure(VAC)
Surgical management: sore is excised and closed using a flap
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12. • Treatment options currently being studied:
Hyperbaric oxygen therapy
Electrotherapy
Growth factors
Negative-pressure wound therapy (NPWT)
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14. Complications:
• Sepsis
• Cellulitis
• Osteomyelitis
• Malignant transformation
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15. References
1. Bailey & Love’s Short Practice of Surgery, 26th
Edition
2. Manipal Manual of Surgery, K.R. Shenoy et al,
4th Edition
3. SRB’s Manual of Surgery, S. Bhat M, 4th
Edition
4. www.medscape.com
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