Decubitus ulcer

Synonym:

Pressure sores

Decubitus ulcers in the skin are induced by ischemia. The basis of ischemia is usually prolonged pressure.

Pressure sores are commonly found in bedridden patients left in a fixed position for long periods of time, or in paraplegics, again for the same reason.

Erythema overlying a bony prominence can precede ulceration.

Treatment:

• Prevention depends upon maintaining good blood flow to all load bearing areas of the skin. For the bedridden patient this involves weight shifting at regular intervals; certainly every 15 to 20 minutes ideally more often. Air mattresses that inflate and deflate can be quite useful for changing body position without the need for staff help.
• The ulcer itself responds to enhanced blood flow.
• Secondary infection should be treated.
• Damaging and irritant chemicals should be avoided.
• Numerous dressings such as hydrocolloid gels are available. These are very much an improvement over the older chlorine or peroxide solutions, which often slowed healing.
• If there is secondary bacterial overgrowth, anti-bacterial preparations can be used, but only for the few days required to control the bacterial overgrowth.
• Malodorous ulcers may be improved by use of topical 0.75% metronidazole gel bid.
• In the case of debilitated patients, care should be taken to be sure that they are in a good metabolic state.
• The edge of ulcers that refuse to heal over many months should be biopsied to rule out an underlying squamous carcinoma.

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