Management of Bedsores
Management and treatment of bedsores (pressure-induced skin and soft tissue injuries) must include an appraisal of the patient’s general health. The evaluation of the wound is also part of management, since it is also used to judge progress of treatment.
Nutritional assessment should be made and changes implemented by a dietitian/nutritionist if there is concern for malnutrition.
Close daily surveillance of the bedsore(s) is necessary, and attention to the dressing, surrounding skin, and investigations into possible occult deeper tissue injury should be made.
Adequate pain control is part of management.
Evidence of infection (weeping, foul odor, or treatment failure) should prompt microbial culture and sensitivity testing to drive antibiotic choice for aggressive antimicrobial therapy, and subsequent re-testing as a “test-of-cure” of the therapy.
According to the different stages of ulceration:
- Stage 1 (intact skin with localized nonblanchable erythema): Preventative measures and wound protection with transparent film.
- Stage 2 (partial-thickness loss of skin with exposed dermis): Dressings and maintenance of a moist wound environment.
- Stage 3: (full-thickness loss of skin, exposing fat and granulation tissue): Treatment of any infection, debridement of non-vitalized tissue, and appropriate dressings.
- Stage 4: (full-thickness loss of skin and tissue loss with exposed fascia, muscle, tendon, ligament, cartilage, or bone): Treatment of any infection, debridement of non-vitalized tissue, appropriate dressings, and surgery for some full-thickness wounds.
Procedures such as direct closure, skin grafting, musculocutaneous and free flaps can be considered to hasten the progress if rapid wound coverage is necessary for the best outcomes.