Pressure Ulcer

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    • Stage I - only superficial (erythema)
    • Stage II - partial thickness skin loss
    • Stage III - full thickness skin loss, underlying fat exposed
    • Stage IV - Muscle, bone, or tendon exposed



    • Remove the eschar to determine the stage of ulcer.
    • Multidisciplinary approach
      • 1. Treat predisposing factor 
      • 2. Dressings - keep moist, collect exudates.
      • 3. Infection - topical therapy, systemic abx if cellulitis.
      • 4. Surgical debridement of eschar and other non-viable tissue.
      • 5. Surgical flap - 
        • Only for refractory cases if failed conservative mgmt.
    • No evidence for:
      • Electromagnetic therapy, ultrasound therapy, hyperbaric oxygen therapy.
      • Negative-pressure:
        • Has been used for sage IV ulcers.
        • Three clinical triasl: no superiority to standard care.
        • More convenient than daily dressing changes, but very costly. (not recommended first line). 
      • Zinc, vitamin C,
    • Reference:
      • Reddy M, Gill SS, Kalkar SR, et al. Treatment of pressure ulcers: a systematic review. JAMA. 2008;300(22):2647-2662. PMID: 19066385
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