Your doctor will look closely at your skin to determine whether you have a pressure ulcer and how bad the damage is. He or she will try to assign a stage to the wound. Staging helps determine what treatment is best for you. He or she might also order a blood test to assess your general health.
Questions from the doctor
Your doctor might ask questions such as:
- When did the pressure sore first appear?
- What is the degree of pain?
- Have you had pressure sores in the past?
- How were they managed, and what was the outcome of treatment?
- What kind of care assistance is available to you?
- What is your routine for changing positions?
- What medical conditions have you been diagnosed with, and what is your current treatment?
- What is your normal daily diet and fluid intake?
Treating pressure ulcers involves reducing pressure on the affected skin, caring for the wounds, controlling pain, preventing infection and maintaining good nutrition.
Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of your care team might include:
- A primary care physician who oversees the treatment plan
- A physician or nurse specializing in wound care
- Nurses or medical assistants who provide both care and education for managing wounds
- A social worker who helps you or your family access resources and who addresses emotional concerns related to long-term recovery
- A physical therapist who helps with improving mobility
- An occupational therapist who helps to ensure appropriate seating surfaces
- A dietitian who monitors your nutritional needs and recommends a good diet
- A doctor who specializes in conditions of the skin (dermatologist)
- A neurosurgeon, orthopedic surgeon or plastic surgeon
The first step in treating a bedsore is reducing the pressure and friction that caused it. Strategies include:
- Repositioning. If you have a pressure sore, turn and change your position often. How often you reposition depends on your condition and the quality of the surface you are on. Generally if you use a wheelchair, try shifting your weight every 15 minutes or so and change positions every hour. If you're in a bed, change positions every two hours.
- Using support surfaces. Use a mattress, bed and special cushions that help you sit or lie in a way that protects vulnerable skin.
Cleaning and dressing wounds
Care for pressure ulcers depends on how deep the wound is. Generally, cleaning and dressing a wound includes the following:
- Cleaning. If the affected skin is not broken, wash it with a gentle cleanser and pat dry. Clean open sores with water or a saltwater (saline) solution each time the dressing is changed.
- Putting on a bandage. A bandage speeds healing by keeping the wound moist. This creates a barrier against infection and keeps the surrounding skin dry. Bandage choices include films, gauzes, gels, foams and treated coverings. You may need a combination of dressings.
Removing damaged tissue
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, such as gently flushing the wound with water or cutting out damaged tissue.
Other interventions include:
- Drugs to control pain. Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — might reduce pain. These can be very helpful before or after repositioning and wound care. Topical pain medications also can be helpful during wound care.
- Drugs to fight infection. Infected pressure sores that aren't responding to other interventions can be treated with topical or oral antibiotics.
- A healthy diet. Good nutrition promotes wound healing.
- Negative pressure therapy. This method, which is also called vacuum-assisted closure (VAC), uses a device to clean a wound with suction.
A large pressure sore that fails to heal might require surgery. One method of surgical repair is to use a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).
Coping and support
People with pressure sores might experience discomfort, pain, social isolation or depression. Talk with your care team about your needs for support and comfort. A social worker can help identify community groups that provide services, education and support for people dealing with long-term caregiving or terminal illness.
Parents or caregivers of children with pressure ulcers can talk with a child life specialist for help in coping with stressful health situations.
Family and friends of people living in assisted living facilities can be advocates for the residents and work with nursing staff to ensure proper preventive care.