Pressure Injuries AND Wound Care

Meet the patient

Mrs T is an 82-year-old admitted with a dense right hemiplegic stroke. On day 5 the nurse reports a "sore" on her sacrum. You find a 4-centimetre full-thickness ulcer with visible fat, a rim of surrounding cellulitis, and exposed-appearing bone at the base. The question that decides her outcome is not the stroke — it is whether you stage it correctly, exclude osteomyelitis, relieve the pressure, and treat the infection before it becomes sepsis.[1][12]

Hold those four levers — stage, exclude osteomyelitis, relieve pressure, treat infection — and the whole topic falls into place.[1]

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1. [1]Kottner J, Cuddigan J, Carville K, et al. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019 J Tissue Viability, 2019.PMID 30658878
2. [2]McInnes E, Jammali-Blasi A, Bell-Syer SE, et al. Support surfaces for pressure ulcer prevention Cochrane Database Syst Rev, 2015.PMID 26333288
3. [3]Yap TL, Horn SD, Sharkey PD, et al. Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: TEAM-UP Trial Results Adv Skin Wound Care, 2022.PMID 35051978
4. [4]Bergstrom N, Horn SD, Rapp M, et al. Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes Ont Health Technol Assess Ser, 2014.PMID 26330893
5. [5]Forni C, Gazineo D, Allegrini E, et al. Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: Randomized controlled trial Int J Nurs Stud, 2022.PMID 35124474
6. [6]Hahnel E, El Genedy M, Tomova-Simitchieva T, et al. The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial Br J Dermatol, 2020.PMID 31628863
7. [7]Moore ZEH, Patton D Risk assessment tools for the prevention of pressure ulcers Cochrane Database Syst Rev, 2019.PMID 30702158
8. [8]Huang C, Ma Y, Wang C, et al. Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis Nurs Open, 2021.PMID 33630407
9. [9]Langer G, Wan CS, Fink A, et al. Nutritional interventions for preventing and treating pressure ulcers Cochrane Database Syst Rev, 2024.PMID 38345088
10. [10]Beeckman D, Van Lancker A, Van Hecke A, et al. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development Res Nurs Health, 2014.PMID 24700170
11. [11]Shi J, Gao Y, Tian J, et al. Negative pressure wound therapy for treating pressure ulcers Cochrane Database Syst Rev, 2023.PMID 37232410
12. [12]Wong D, Holtom P, Spellberg B Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy Clin Infect Dis, 2019.PMID 29986022
13. [13]Arowojolu OA, Wirth GA Sacral and Ischial Pressure Ulcer Management With Negative-Pressure Wound Therapy With Instillation and Dwell Plast Reconstr Surg, 2021.PMID 33347064