Pressure sore\ulcer

Definition:
Pressure ulcers are defined as localized areas of tissue
necrosis that develop when soft tissue is compressed
between a bony prominence and an external surface for a
prolonged time.
They have been referred by many names, including:

- Bed sore.
- Pressure sore.
- Pressure ulcer.
- Dermal ulcer.

Factors contributing to pressure ulcers:

a. Pressure – force placed on tissues. Pressure that exceeds
capillary filling pressures of 12-32 mmHg for more than
two hours will result in tissue damage.
b. Shear – it causes mechanical destruction of deep
tissues, occurring when underlying tissues are pulled in
one direction due to gravity and skin tissues remain in
place; results in ischemia and tissue death.
c. Friction – occurs when skin is moved across a surface
such as sheets. Results in abrasion-type wound.
d. Moisture – from incontinence or diaphoresis; leads to
maceration of tissues.

Stages of pressure sore:

a. Stage I: redness area warmth to touch, no exudates or
sign of skin breakdown.
b. Stage ii: loss of skin layer [epidermis-dermis] with
blister, pinkish and painful.
c. Stage iii: thickness skin loss involving damage or
necrosis subcutaneous tissue [infected wound with
slaph].
d. Stage iiii: deep wound that reaches the bones, this
need skin graft.
Kinds of dressing for each stage:
A. Stage I:
- Clean with saline.
- Apply hydrocolloid e.g. thin duoderm patch.
- To change it every 3-5 days or PRN.
B. Stage ii:
- Open wound which is clean dry or with minimal
exudates.
- Apply thick duoderm patch.
C. stage iii:
• usually moderate to heavy exudates:
- Apply hydrogels and aquacell plain.
- Cover with allevyn patch.
• if infected with moderate to heavy exudates:
- Apply aquacell silver.
- Change it every 3 days [when spotting is observed on
the dressing].
D. necrotic wound – to apply aquacell silver and duoderm
gel.

Burns:
- mebo [ moist exposed burns ointment] – creates an
favorable atmosphere for bacterial and fungal
infection. To apply mebo it should be with thick layer
and to cover it with opsite and to change it twice a day.
- Flamazine – prevents and treats bacterial infections in
burn, leg ulcers or pressure ulcer for a short time. We
should apply a thick layer of flamazine and cover it
with opsite and change it daily.
- Bactigras – this is an antimicrobial sheet, it contains
chlorhexidine acetate which gives long lasting action
against gram positive and negative bacteria.
- Aquacell silver – to apply double sheets for redness
burn with blisters and to change it after 14 days.
- Burns with thickness layer need for skin graft.

Additional information:
 - aquacell silver it is good with diabetic ulcer, infected
pressure ulcer, veno ulcer and oncology wound.
- No need to moisturize the aquacell silver sheet.
- Kaltostat – this kind of dressing it is good to stop the
mild bleeding. We can use it with cellilits, dipredment,
surcumsecion and on the wound of the donor side.
- To change the dressing of the kaltostat every 2-3 days.

Ghada.