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Pressure Sores
The treatment of pressure sores is often one of the most difficult challenges of plastic surgery. Commonly, patients with pressure sores present acutely with signs of systemic infection. Pressure sores are a chronic problem in sedentary patients with multiple systemic problems. Thus it is essential to keep in mind that the likely source of acute systemic infection is not the sore itself. Each case warrants a complete evaluation by the examiner to rule out the pressure sore as the likely cause of the infection.
Pressure Sore Staging System (Fig. 3–1)
Stage 1 | Intact skin with nonblanchable erythema |
Stage 2 | Superficial ulcer involving partial thickness of the epidermis and dermis; usually presents as an abrasion, blister, or very shallow ulcer |
Stage 3 | Full-thickness skin loss down to the subcutaneous tissue, which does not extend beyond underlying fascia |
Stage 4 | Full-thickness skin loss down through subcutaneous tissue with involvement of muscle, bone, tendon, ligament, or joint capsule |
Evaluation
• Position the patient in a well-lighted area to facilitate visualization of the ulcer.
• Gently probe the wound and assess for fluid collections or purulent drainage. If pus is present, incision and drainage (I&D) should be performed and the wound irrigated copiously and packed wet to dry (see below). Obtain a culture and samples of the purulent material.
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