Current concepts in clinical therapeutics: pressure sores.

The etiology, pathophysiology, clinical presentation, prevention, management, and complications of pressure sores are reviewed. Three specific patient populations are at high risk of developing pressure sores: spinal-cord-injury, geriatric long-term-care, and orthopedic patients. Pressure sores usually develop at bony prominences on the body as a result of four etiologic elements: pressure, shearing forces, friction, and moisture. Excessive pressure causes poor tissue perfusion, which is normally compensated for by shifts in body position. However, in these patient populations, various abnormalities prevent patients from recognizing or compensating for this pressure. Once a lesion forms, it may progress through four stages marked by worsening necrosis, infection, and tissue loss. The best treatment of pressure sores is prevention. Various mechanical devices may assist the patient in decreasing or distributing pressure, but quality nursing care is essential for debilitated or disabled patients. If a pressure sore develops, treatment should focus on (1) eliminating local pressure, (2) cleaning and removing necrotic tissue, (3) creating a tissue-growth environment, and (4) treating factors that retard wound healing. Drug therapy includes agents for chemical cleansing and debridement of pressure sores and systemic antibiotics for complications such as septicemia or osteomyelitis. Despite efforts to improve treatment of pressure sores, prevention remains the best treatment.