Management of pressure ulcer

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.The National Pressure Ulcer Advisory Panel Literature reviews demonstrate several etiologies of pressure ulcers. Earlier reviews focused on a model of pressure ulcer development caused by pressure-induced capillary closure cutting off blood supply and leading to tissue ischemia, injury, and death. The cells are deprived of oxygen and nutrients, waste products of metabolism accumulate in the cells, and the tissue consequently dies. More recent research, using techniques such as magnetic resonance imaging (MRI), has documented cellular distortion and damage from pressure. There is also a renewed appreciation for the effects of shear in damaging deeper tissue and microclimate (moisture and temperature) in rendering tissue less tolerant of the effects of pressure. After the skin has been compressed, it appears pale, as if the blood had been squeezed out of it. When pressure is relieved, the skin takes on a bright red flush called reactive hyperthermia. The flush is due to vasodilatation, a process in which extra blood supply to compensate for the preceding period of impeded blood flow. Elements of pressure ulcer prevention include identifying individuals at risk for developing pressure ulcers, preserving skin integrity, treating the underlying causes of the ulcer, relieving pressure, paying attention to the total state of the patient to correct any deficiencies, and educating the patient and his or her family about pressure ulcers. Numerous intrinsic factors affect the ability of the skin and supporting structures to respond to pressure and shear forces these factors include age, spinal cord injury, nutrition, and steroid administration ، Systemic blood pressure, extracorporeal circulation, serum protein, smoking, hemoglobin and hematocrit, vascular disease, diabetes mellitus, vasoactive drugs.