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Treatment for Pressure Sores


Treating pressure sores is not easy. If the sore is an open wound then it most likely will not heal quickly and even when it does heal, it could be patchy as the skin and other tissues have been damaged already. A multidisciplinary approach is needed to manage the many aspects of care and the NHS states that the team managing this may consist of:

– A gastroenterologist (doctor specialising in the digestive system)
– A neurosurgeon (brain and nervous system specialist)
– An orthopaedic surgeon (bone and joints specialist)
– A dietician
– A physiotherapist
– A plastic surgeon
– A social worker
– An incontinence advisor
– A urologist (doctor specialising in the urinary system)
– Nurses

The first step in treating a pressure sore at any of the four stages is to actively remove the pressure that is causing it by:

Altering the patient’s positions Patients must be turned and repositioned at regular intervals. For wheelchair-bound patients, this may mean changing positions every 15 minutes but for bed-bound patients it might be every couple of hours. Placing some padding or sheepskin over the wound might help to minimise friction when the patient is being repositioned.

Putting support surfaces in place Special mattresses, beds, pads and cushions could all help to reduce the amount of pressure on a sore, whilst also protecting areas likely to suffer from a further breakdown. The type of support that is used will depend on the patient’s mobility, build and the severity of the sore, for example rubber rings and pillows should not be used to cushion a wheelchair because water-filled, air-filled or foam devices are much suitable. With beds, low-air-loss beds and air-fluidised beds are believed to be best.

Non-surgical treatments

Clean wound The wound needs to be kept clean and can be washed gently with water and mild soap if it is at Stage I. However, open sores must be cleaned with a saline solution when the dressing is changed. You should avoid iodine or hydrogen peroxide.

Continence This needs to be controlled as much as possible. The patient can be assisted with behavioural programmes, lifestyle changes, incontinence pads and certain medications.

Debridement If there is dead or infected tissue in the wound then it will not heal well and will need to be removed using one of the following methods:

– Surgical debridement – this is where the doctor will use a scalpel to take away the dead tissue (there are other devices available too)
– Mechanical debridement – a high-pressure irrigation device will be used here to remove devitalised tissue
– Autolytic debridement – this is where the body’s own enzymes will break down the dead tissue
– Enzymatic debridement – here, topical debriding enzymes are applied
– Ultrasound – dead tissue is removed with low-frequency energy waves
– Laser – dead tissue is removed with focused light beams

Maggot therapy (also known as larvae therapy) This is an alternative form of debridement. Here, the maggots will feed on the dead and infected tissue but will not disturb the healthy tissue. The maggots release a substance that will kill bacteria and encourage healing, too. They are placed into the wound dressing and the space is covered with gauze. Then, a couple of days later the dressing and maggots are removed.

Dressings Dressings are key to protecting a wound and speeding up healing. The type of dressing that is used depends on how severe the wound is. First and foremost the wound needs to be kept moist, and the surrounding tissue dry. A Stage I sore usually doesn’t require any covering and generally, Stage II wounds are treated with hydrocolloids, or a transparent semi-permeable dressing that holds the moisture in and speeds up skin cell growth. For weeping wounds or those with surface debris, special dressings may need to be used and an antibiotic cream can be used for contaminated sores.

Hydrotherapy The skin can be kept clean with whirlpool baths which might naturally eliminate dead or contaminated tissue too.

Oral antibiotics The patient may be given oral antibiotics if the pressure ulcers are infected.
Nutrition The healing of the wound healing could potentially be enhanced if the patient makes a conscious effort to eat properly. This includes eating sufficient vitamins and minerals (particularly vitamin C and zinc) ensuring an adequate intake of protein and plenty of calories.

Muscle spasm relief Skeletal muscle relaxants that block the spine’s nerve reflexes or that in the muscle cells could alleviate spasticity.

Surgery

Many pressure sores at Stages I and II will heal within a few weeks with only conservative measures, however those at Stages III and IV might require surgery.

The aim of surgery is to improve the sore’s appearance, clean and treat it or prevent infection. It might also help to reduce fluid loss as well as lowering the risk of the sufferer developing a cancer.

Typically during surgery a pad of muscle, skin or other tissue from the patient’s body is used to shield the wound and cushion the affected bone (also called flap reconstruction).

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Claiming For Medical Negligence 


Clinical Negligence Claim

There are times that the medical procedures and care we receive may fall short of everything you expect to receive, and things can go drastically wrong, leaving you worse off and perhaps, severely injured. Watch our medical negligence videos for more information about making a medical claim.

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