Pressure ulcer treatment

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Did you know that

„Pressure ulcers can occur quickly - between the first hour and 4 to 6 hours after sustained loading.“

– A. Gefen (1)

„One to four of every ten hospitalized patients develop pressure ulcers.“

– Range varies among settings and classification method. (2)

„In areas affected by COVID-19 lockdown only 22,6% of patients with chronic wounds went to the wound clinics as usual, and 1 in 10 did not change the wound dressing at all during that whole period.“

– Tinelli, G. et al. (3)

It's time to act

Most of the time, pressure sores significantly impact the patients’ morbidity, mortality and quality of life. Once a pressure ulcer has developed, it is important to draw up a coordinated treatment plan to promote healing. The basic prerequisites for wound healing must be met and everything that interrupts this process needs to be avoided. These include pressure ease, a clean wound, functioning circulation, and adequate nutrition in terms of both calories and nutrients along with adequate fluid intake.

Care of stage 1 pressure sores

Depending on the extent of tissue damage, pressure sores are categorized into four stages(4). Every stage requires a specific treatment.

Stage 1 pressure ulcers

Description

Non-blanchable erythema of intact skin; superficial

Goal

  • Skin repair
  • Restore capillary function
  • Protect against friction

How to care for stage 1 pressure ulcers

Askina® Heel and Askina® DresSil Border Lite

Protect from friction

Askina® Heel(10) is a non adhesive hydrocellular heel dressing that protects the heel area from shear stresses and reduces pressure from external forces.

 

Treatment of stage 2 pressure sores

Stage 2 pressure ulcers

Description

Partial-thickness skin loss with exposed dermis; superficial

Treatment goals

  • Remove blisters
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin
Prontosan® Debridement Pad, Prontosan® Wound Irrigation Solution Prontosan® Gel X

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® Paste, Askina® Calgitrol® Thin, Askina® Calgitrol® AG

Treat local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix which in the presence of wound exudate helps maintain a moist wound environment conducive to natural healing conditions.

Askina® Carbosorb

Manage wound odour

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodour.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina DresSil, Askina® DresSil Border, Askina® Foam, Askina® Heel

Manage wound exudate

Askina® DresSil Sacrum(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Treatment of stage 3 pressure sores

Stage 3 pressure ulcers

Description

Full-thickness skin loss; deep

Treatment goals

  • Debride
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin
Prontosan® Debridement Pad, Prontosan® Wound Irrigation Solution Prontosan® Gel X

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® Paste, Askina® Calgitrol® Thin, Askina® Calgitrol® AG

Treat local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix providing a broad spectrum antimicrobial effectiveness on infected wounds and preventing contamination from external bacteria.

Askina® Carbosorb

Manage wound odour

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodour.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina DresSil, Askina® DresSil Border, Askina® Foam, Askina® Heel

Manage wound exudate

Askina® DresSil Sacrum(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Treatment of stage 4 pressure ulcers

Stage 4 pressure ulcers

Description

Full-thickness skin and tissue loss; deep

Treatment goals

  • Debride
  • Protect organs
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin
Prontosan® Debridement Pad, Prontosan® Wound Irrigation Solution Prontosan® Gel X

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® Paste, Askina® Calgitrol® Thin, Askina® Calgitrol® AG

Treat local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix providing a broad spectrum antimicrobial effectiveness on infected wounds and preventing contamination from external bacteria.

Askina® Carbosorb

Manage wound odor

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodour.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina DresSil, Askina® DresSil Border, Askina® Foam, Askina® Heel

Manage wound exudate

Askina® DresSil Sacrum(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

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References:

1) Gefen, A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/18927481"Ostomy Wound Manage. 2008 Oct;54(10):26-8, 30-5.

2) Range varies among settings and classification method. 

  • Bereded DT, Salih MH, Abebe AE. Prevalence and risk factors of pressure ulcer in hospitalized adult patients; a single center study from Ethiopia. BMC Res Notes. 2018;11(1):847. Published 2018 Nov 29. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC626787
  • Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007;13(2):227-35. (https://www.ncbi.nlm.nih.gov/pubmed/17378869)
  • Barrois B, Labalette C, Rousseau P, et al. A national prevalence study of pressure ulcers in French hospital inpatients. J Wound Care. 2008;17(9):373-6, 378-9. (https://www.ncbi.nlm.nih.gov/pubmed/18833894)
  • Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care. 2008;13(2):71-9 (https://www.ncbi.nlm.nih.gov/pubmed/18289185)
  • Vangilder C, Lachenbruch C, Algrim-boyle C, Meyer S. The International Pressure Ulcer Prevalence™ Survey: 2006-2015: A 10-Year Pressure Injury Prevalence and Demographic Trend Analysis by Care Setting. J Wound Ostomy Continence Nurs. 2017;44(1):20-28.(https://www.ncbi.nlm.nih.gov/pubmed/27977509)

3) Tinelli G, Sica S, Guarnera G, Pitocco D, Tshomba Y. Wound Care during COVID-19 Pandemic [published online ahead of print, 2020 Jun 24]. Ann Vasc Surg. 2020;S0890-5096(20)30545-8. doi:10.1016/j.avsg.2020.06.044; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311334

4) Haesler E (Ed.) EPUAP/NPIAP/PPPIA, (2019), Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance

5) López-Pérez R, Gutiérrez Ibáñez B, Incidence of pressure ulcers (bed sores) in patients on treatment with hyperoxygenated fatty acids. (Asturias, Spain). Unpublished.

6) Instructions for use Linovera®

7) Jimenez Torres J. (2010), Acidos Grasos Hiperoxigenados (AGHO) en el tratamiento y prevencion de las ulceras por presion, ulceras vasculares y pie diabetico. Panorama actual del medicamento 2010; 34(336):695-701

8) Declair V, (1997), The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers. Ostomy Wound Manage 43(5):48-52, 54.

9) Colin D, Chomard D, Bois C, Saumet JL, Desvaux B, Marie M, (1998), An evaluation of hyper-oxygenated fatty acid esters in pressure sore management. J Wound Care 7(2):71-2.

10) Cf. Instruction for use: Askina® Heel, Askina® DresSil Border Lite, Prontosan® Wound Irrigation Solution, Prontosan® Gel X, Prontosan® Debridement Pad

11) Moore M, (2016), 0.1% Polyhexanide-Betaine Solution as an Adjuvant in a Case-Series of Chronic Wounds. Surg Technology International.

12) Bellingeri A, Falciani F, Traspedini P, et al, (2016), Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. J Wound Care. 25(3):160-168. doi:10.12968/jowc.2016.25.3.160.

13) Cf. Instruction for use: Askina® Calgitrol® Paste, Askina® Calgitrol® Thin, Askina® Calgitrol® Ag, Askina® Carbosorb, Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border, Askina® Foam, Askina® Sorb Rope, Askina® Barrier Cream, Askina® Barrier Film Spray, Askina® Barrier Film Swabs.

14) Downie F, Sandoz H, Gilroy P, Royall D, Davies S, (2013). Are 95% of hospital-acquired pressure ulcers avoidable?. Wounds UK. 9. 16-22.3