***This page is under review***
Pressure sores are notoriously difficult to mange, especially where the predisposing factors have not or cannot be corrected. Prophylaxis is always preferable to treatment if possible.
Once a sore has developed, appropriate measures should be undertaken to reduce or eliminate pressure in the area making use of modified pressure-relieving mattresses and cushions as well as regular mobilisation, assisted as necessary. Other important measures include optimising nutritional status and smoking cessation. A multivitamin is usually recommended.
Formal surgical debridement may be required where there is extensive necrotic tissue in the wound and or evidence of soft tissue of bone infection.
Conservative measures are usually pursued aggressively in order to try to heal the wounds and avoid the need for reconstructive surgery using local flaps. The dressings clinic at St John’s Hospital will help in the combined management of selected patients and offer their advice.
Surgical intervention may be considered for wounds that fail to progress despite adequate conservative intervention and for some infected or necrotic wounds. Biopsies may also been indicated to exclude a Marjolin’s ulcer (SCC). Surgery is highly prone to complications and further wound breakdown, especially when the predisposing factors persist.
Who to refer:
- Pressure sores with evidence of extensive necrosis and / or infection.
- Pressure sores that fail to progress despite the institution of appropriate conservative measures.
Who not to refer:
- Pressure sores in moribund patients where the sore itself is not significantly contributing to their ill health.
- Poorly compliant patients who are unlikely to follow recommendations.
- Patients that are making adequate progress with intervention instituted in the community.
How to refer:
Via the SCI gateway to the Plastic Surgery service at St John’s hospital with appropriate details and background information.
