Pressure Sore

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.

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Open wound which is clean dry or with minimal exudates. Apply thick duoderm patch.

B. Stage ii: -

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

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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:

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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.