Treatment of pressure sores is more difficult than preventing them. Skin care and movement are vital for the prevention of pressure sores. Moisture increases the likelihood of developing pressure sores, so skin should be kept clean and dry. Thick creams should be applied to the areas prone to developing pressure sores and sheets and clothing should be changed often. Cornstarch should not be used to prevent moisture and friction, as it allows microorganisms to grow.
Caretakers can also use cushioning, wedges, pillows, and protectors to reduce body pressure for those confined to their bed and wheelchair, but these things are not a substitute for frequent repositioning.
If proper measures were not taken to prevent pressures sores and they are now present, treatment should begin as soon as possible. The key is to relieve pressure on those parts of the body, clean and dress the sores appropriately, and control the infection. Pressure sores that are deeper or infected may require surgical intervention.
Wound Cleaning and Dressing
For proper healing, pressure sores need to be cleaned, dead skin debrided (removed), and wound dressings then applied.
Cleaning of pressure sores needs to be done fairly frequently depending on the severity of the sore. A caregiver will remove the wound dressing and irrigate the wound with saline solution to clean and loosen any debris that may be deep in the wound.
For deeper pressure sores, a doctor may need to use chemical solutions, scalpel, or biosurgery to remove the dead tissue in that area. This process is usually painless, but pain may be felt in the neighboring, healthy tissue. Wound dressings are used to protect the area and promote healing. All pressure sores can benefit from dressings, although they are typically used in wounds that are a stage 2 or higher. The type of wound dressing used depends on the amount of drainage from the pressure sore, but will typically be one of the following:
- Transparent films or hydrogels-Help to protect early stage pressure sores with minimal drainage. Transparent films are changed every 3-7 days.
- Hydrocolloid patches-These patches protect pressure sores and provides a healthy healing environment for sores with light to moderate drainage. Hydrocolloid patches are changed every three days or sooner if drainage is substantial.
- Alginates-Alginates are made from seaweed and are made into pads, ropes, or ribbons. Alginates are used for sores that have a large amount of drainage and should not be left on for longer than 7 days.
- Foam dressings-Foam dressings are often waterproof for areas such as the buttocks and armpits to prevent the formation of pressure sores due to sweat, urine, or feces and must be changed every 3-4 days.
Surgery
Deep pressure sores are difficult to treat and even with surgical intervention, these wounds may not completely heal. For pressure sores that are large, but shallow, may benefit from a skin graft. If a pressure sore is located over bonier areas of the body, a muscle flap may be used to close the open wound.
Pain Management and Infection Control
Pressure sores are painful. Doctors will often try to use NSAID’s and acetaminophen as opposed to opioids, as the latter will discourage movement.
Topical antibiotics are often applied to the pressure sores as well as given orally. If infection has spread to the bloodstream or to the bones, IV antibiotics will be given.
Nutrition
Undernutrition and malnutrition are common in those with pressure sores. A nutrition specialist should be consulted, and a well-balanced, high protein diet is often recommended. For those that cannot or will not eat nutritiously, tube-feeding and IV feeding are options. Vitamin supplementation should also be considered for those with deficiencies.
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