Treatment Of Pressure Ulcers Research Articles

Pressure ulcer or moisture lesion? How to tell the difference

Nursing staff caring for patients in hospital and in the community normally receive education and training in how to assess skin for pressure ulcer risk. Staff are taught how to reduce risks, to document any pressure ulcers and how to treat pressure ulcers. Many people, however, are at risk of moisture damage due to incontinence, excessive perspiration, wound and stoma exudate. Moisture damage can cause pain and discomfort, delay hospital discharge and impact on quality of life, yet few staff receive formal education on this subject. This article aims to enable readers to understand the difference between moisture damage and pressure damage when inspecting skin. It aims to enable staff to provide effective care and treatment.

Economic evaluation of nutritional support in the prevention and treatment of pressure ulcers in acute and chronic care settings – a systematic review

Economic evaluation of nutritional support in the prevention and treatment of pressure ulcers in acute and chronic care settings – a systematic review

Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review.

Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs. A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology. Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations. Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.

Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial.

To evaluate the effectiveness of topical pentoxifylline (PTX) on pressure ulcer (PU) healing in critically ill patients. In this randomised, double blind, placebo-controlled clinical trial, patients with category I or II PUs were randomly assigned to receive either topical PTX 5% or a placebo twice daily for 14 days. Changes in PU characteristics (category and size) were assessed. The category of the PU was determined by the Stirling Pressure Ulcer Severity Scale (two-digit) at baseline (day zero), day seven and day 14 of treatment. PU length and width was measured with a disposable ruler and expressed as cm2. A total of 112 adult patients were enrolled in the study. Median PU size and score at day zero were 32 (10.00-69.33)cm2 and 1(1.00-2.00) respectively. In the PTX group, the mean differences (95% confidence interval, CI) of all PU scores and sizes decreased significantly across the intervals (day seven versus day zero, day 14 versus day zero, and day 14 versus day seven), compared with the placebo group Conclusion: The severity and size of PUs improved significantly in patients who received topical PTX 5% ointment twice a day for 14 days compared with those in the placebo group. Topical PTX may be considered as a potential option in the treatment of categories I and II PUs in critically ill patients.

Hydrogel wound dressings loaded with PLGA/ciprofloxacin hydrochloride nanoparticles for use on pressure ulcers

The aim of this research study was to develop polyvinyl alcohol (PVA) hydrogels containing ciprofloxacin hydrochloride (CIP)-loaded poly (lactic-co-glycolic acid) (PLGA) nanoparticles as antibacterial materials capable of supporting the treatment of infected pressure ulcers. Either 6.25 mg, 39 mg, or 244 mg of CIP was loaded onto PLGA nanoparticles by using the double emulsion technique. The morphology of the resulting CIP-loaded PLGA nanoparticles was spherical, and the mean diameters were approximately 625.3–957.9 nm. Later, polyvinyl alcohol (PVA) hydrogels loaded with CIP/PLGA nanoparticles were prepared and crosslinked with gamma radiation. The greatest cumulative quantities released from the CIP/PLGA-loaded PVA hydrogels containing 6.25 mg, 39 mg, and 244 mg CIP were 43.38%, 79.75% and 94.63%, respectively. The CIP/PLGA nanoparticles and CIP/PLGA-loaded PVA hydrogels were observed to provide an effective antimicrobial response when exposed to Escherichia coli and Staphylococcus aureus. Furthermore, the performance in terms of cell viability had no adverse influence upon the absence of cytotoxicity, as indicated in tests carried out using normal adult human fibroblast cells. It was thus concluded that the CIP/PLGA-loaded hydrogels may be considered as potentially beneficial materials for application in wound dressings with antibacterial properties.

Surgical treatment and strategy in patients with multiple pressure sores.

Pressure sores remain a common health problem, particularly among the physically limited or bedridden elderly, and can cause significant morbidity and mortality. This study aimed to present our surgical treatment and strategy for patients with multiple pressure sores. Between January 2010 and December 2016, 18 patients were enrolled. After adequate debridement, pressure sores were managed based on our treatment protocol. Patients' age, aetiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. A total of 10 men and 8 women (average age, 82.3 years) with a mean follow-up period of 28.3 months (6-72 months) were included. The mean defect area was 63.7 cm2 . The most common aetiology of the bedridden state was cerebrovascular accident (38.89%), and the most frequent sores were trochanteric pressure sores (53.57%). The average operative time and blood loss were 105.5 minutes and 100.8 mL, respectively. No haemodynamic variation or blood transfusion was noted during the surgery. The complication rate for each sore was 10.7%, including late recurrence. In conclusion, treating pressure ulcers requires careful patient education, intensive multidisciplinary optimisation, and meticulous wound care, and our treatment protocol ensures a shorter surgery time, less bleeding, and low complication rate.

Macrogol versus Vaseline in the Treatment of Superficial Sacral Pressure Ulcers: A Retrospective, Comparative Study

目的：近年，基剤に注目した外用薬の選択が推奨され，マクロゴール（macrogol； MAC）が上皮化を促進すると注目されている．仙骨部のd2褥瘡（真皮までの損傷）に対するMACの効果を，ワセリン（vaseline； VAS）と比較して後方視的に検討した．

A Descriptive, Cross-sectional Study to Assess Pressure Ulcer Knowledge and Pressure Ulcer Prevention Attitudes of Nurses in a Tertiary Health Institution in Nigeria

Globally, higher-than-expected pressure ulcer rates generally are considered a quality-of-care indicator. Nigeria currently has no national guidelines for pressure ulcer risk assessment, prevention, and treatment. A descriptive cross-sectional study was conducted to assess the pressure ulcer knowledge and the attitude of nurses regarding pressure ulcer prevention in a tertiary health institution in Nigeria. During a period of 2 months, nurses were recruited to complete a 25-item paper/pencil survey that included participant demographic information (6 items), pressure ulcer knowledge questions (11 items), and statements on participants' attitude toward pressure ulcer prevention (8 items). Data were entered manually into statistical analysis software, analyzed, and presented using descriptive statistics (frequencies and percentages). The majority of the 90 nurse participants were female (60, 66.7%), 45 (50%) were married, and 75 (83.3%) had 1 to 10 years' experience in nursing practice; 69 (76.7%) had received special training on pressure ulcer prevention. Overall, 58 (64.4%) nurses had correct pressure ulcer knowledge and 67 (74.4%) had a positive attitude toward preventing pressure ulcers. However, 56 nurses (62.2%) disagreed with regular rescreening of patients whom they deemed not at risk of developing pressure ulcer, and 70 (77.8%) believed pressure ulcer prevention should be the joint responsibility of both nurses and relatives of the patients. Thus, the majority of the 90 nurses knew the factors responsible for pressure ulcers and how to prevent them, but nurses need to be orientated to the fact that pressure ulcer risk screening of all patients with limited mobility is an integral part of their job and that it is important that nurses enlighten patients and their relatives on how to prevent pressure ulcers.

Research and invention of sinus cavity flushing drainage tube and clinical application in the minimally invasive treatment of sinus cavity pressure ulcer

To develop a washing tube for minimally invasive treatment of sinus cavity pressure ulcer, and to observe its clinical effect. Using transparent non-toxic PU plastic to make sinus cavity flushing and drainage tube, and with rounded hemispherical blunt head for the entry of the sinus, the perforated tube in the sinus cavity was designed with perforated holes (3 rows, 5 for each row); the end of the tube is blocked with heparin cap. The invented sinus cavity flushing tube was used for clinical observation and its use effect was observed. When used, the sinus cavity flushing drainage tube must be placed in the deepest antrum. The wounds were covered with PU sponge. By the active aspiration drainage of the negative pressure with sterile isotonic flushing fluid, bacteria, liquefied necrotic tissue, purulent secretion, internal and external toxins produced by bacteria, and the harmful material such as exudate of inflammatory medium in the sinus cavity was thoroughly removed. When treating sinus cavity and mixed pressure ulcer, minimally invasive treatment using the developed sinus cavity flushing drainage tube for irrigation and negative pressure drainage can significantly reduce patients' iatrogenic trauma, observably reduce the pain of the patients, shorten the treatment cycle, improve the cure rate of sinus pressure ulcers, and achieve good clinical effect. The sinus cavity flushing drainage tube has no damage to soft tissue, with simple operation and easy tolerance of patients. It is low price and using disposable materials, which can avoid cross-infection; It can be used to treat oxygen negative pressure in sinus cavity, and it has therapeutic effect on the sinus cavity pressure sore infected by anaerobic bacteria. It can be made into different specifications, different models, and widely used in different professional fields. The sinus cavity flushing drainage tube combined with negative pressure treatment is a new technique of mild and undamaged cleansing wound, which makes up for the deficiency of flap surgery, and it is a very ideal method for minimally invasive treatment for sinus and cavity pressure ulcers.

Role of Knit Spacer Fabrics in Treatment of Pressure Ulcers

The article highlights some significant trends in the use of knit spacer fabrics in treatment of pressure ulcers. Healing of pressure ulcer wound is complicated and time consuming. Not only affecting the lives of patients and caretakers, but pressure ulcer also becomes the burden to the government. With the developing wound management techniques, companies have launched different wound dressing designed for pressure ulcer. However, regardless for their high price, it is rare that the wound dressing can provide good wound management and cushioning to the wound. Because of the excellent air permeability and compression performance of weft knitted spacer fabrics, it has been applied in different aspects including medical. A theory has been proposed to design a 3D knit spacer bed sheet that will allow patients with pressure ulcers to be comfortable by ensuring a low friction coefficient between their skin and the material. The friction coefficient will be reduced by not only the structure but by the 70 percent polyester, 22 percent polypropylene and eight percent spandex blend.

Research progress on moxibustion therapy for pressure ulcers

This paper summarized the etiology of pressure ulcers in traditional Chinese medicine, the stages of pressure ulcers, the mechanism of action of moxibustion therapy in treating pressure ulcers as well as the status quo of the application of moxibustion therapy in patients with pressure ulcers and looked into its deficiencies, so as to provide a reference for improving the moxibustion therapy for patients with pressure ulcers. Key words: Review; Pressure ulcer; Moxibustion

Deferoxamine can prevent pressure ulcers and accelerate healing in aged mice.

Chronic wounds are a significant medical and economic problem worldwide. Individuals over the age of 65 are particularly vulnerable to pressure ulcers and impaired wound healing. With this demographic growing rapidly, there is a need for effective treatments. We have previously demonstrated that defective hypoxia signaling through destabilization of the master hypoxia-inducible factor 1α (HIF-1α) underlies impairments in both aging and diabetic wound healing. To stabilize HIF-1α, we developed a transdermal delivery system of the Food and Drug Administration-approved small molecule deferoxamine (DFO) and found that transdermal DFO could both prevent and treat ulcers in diabetic mice. Here, we demonstrate that transdermal DFO can similarly prevent pressure ulcers and normalize aged wound healing. Enhanced wound healing by DFO is brought about by stabilization of HIF-1α and improvements in neovascularization. Transdermal DFO can be rapidly translated into the clinic and may represent a new approach to prevent and treat pressure ulcers in aged patients.

Hydrocolloid dressings for treating pressure ulcers

Reason for withdrawal from publication: This protocol has been withdrawn as the topic area is covered by Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD011947. DOI: 10.1002/14651858.CD011947.pub2.

317 Patient Engagement through Advanced Pressure Visualization as a Component of Pressure Injury Prevention

Hospital acquired pressure ulcers represent one of the most frequent health care problems in clinical practice. Burn patients specifically pose a greater challenge due to loss of skin integrity, post-op positioning requirements and high levels of moisture. As an adjunct to unit based standard of care, a new technology was initiated to identify if pressure visualization will encourage patient engagement in repositioning as a component of pressure injury prevention. The purpose of this project is to evaluate the impact of a new advanced pressure visualization (APV) system on patient engagement through visual feedback where body areas are exposed to pressure. The definition of engagement for this purpose is from Gruman, et al, as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” Patients in the Burn Center with intact cognitive awareness and the ability to see and respond to a color screen at the foot of the bed were included. An APV was installed on all beds, which included a pressure sensor mat inside the mattress connected to a display tablet mounted at the foot of the bed. This tablet displays their body image with continuous pressure readings utilizing a color gradient to exhibit pressure values. Patients were educated on the colors reflective of high- low pressures on their individual body image. The color display indicates specific pressure measurements: ‘red’ is >75mmHg, orange is 60-74mmgHg, yellow is 45-59mmHg, green is 30-44mmHg, light blue is 15-29mmHg and dark blue 1-14mmHg. Patients were asked to reposition themselves, or request repositioning assistance from the health care team, to an area of lesser pressure color when areas of high pressure colors (red, orange or yellow) were noted. Data from the APV device was utilized to determine reduction in peak pressure with patient repositioning. Data from 10 patients and 20 repositions were identified. Initial peak pressures shown by APV images, averaged 73.5 mmHg. The average reduction in peak pressure after the ten patients self-repositions was 41.25 mmHg. The National Pressure Ulcer Advisory Panel prevention and treatment guidelines encourage patients to work with the health care team to develop an individualized pressure ulcer prevention plan. With APV, the patient can easily identify high areas of pressure and actively participate in pressure reduction measures. While patient engagement in this population resulted in reduced pressure, further research related to APV and patient engagement for the prevention of pressure injury is warranted.

In vivo study of non-invasive effects of non-thermal plasma in pressure ulcer treatment

According to high incidence and prevalence of pressure ulcers worldwide, the purpose of this study is using of non-thermal atmospheric plasma as a novel therapy for pressure ulcers. Cold plasma was produced by applying a high-voltage (5 kV) and high-frequency (25 kHz), to helium gas. Under general anesthesia and sterile conditions, two circular magnets were used to create pressure ulcers on the dorsal skin of adult rats. The wounds were divided randomly into control and plasma-treated groups. Animals in the plasma-treated group received plasma radiation for 5 days, each day 3 times and every time 60 s. Mechanical assays were performed to determine plasma effects on the mechanical strength of the repaired tissue. The results showed that mechanical strength of repaired wound in the plasma-treated group was significantly higher than that in the control group (p < 0.05). In addition, evidence from histological studies indicates a significantly accelerated wound re-epithelialization in comparison with the control group; angiogenesis and fibrosis (collagen synthesis) were also significantly increased and the inflammation phase of wound healing was shorter in the plasma-treated group. The plasma treatment also resulted in significant wound contraction and acceleration of wound healing. The findings of present study indicate the effects of cold plasma on pressure ulcer treatment.

A Hopeful Prospect of Riociguat as a Soluble Guanylate Cyclase Stimulator for Management of Pressure Ulcers.

Pressure ulcer remains as a common problem, especially developed in disabled patients and hence, subjected to continuous pressure for prolonged periods of time. Most of the studies investigating the preventive and therapeutic approaches have focused on wound cleansing, dressing and supportive strategies, as well as pharmacological therapy including zinc sulphate, vitamin A or phenytoin. Despite such efforts, pressure ulcer continues to impair the life quality and expectancy. Thus involving in the paradigm shift in biomedical studies, the recent ones focus on biological signaling pathways involving nitric oxide (NO)- soluble guanylatecyclase (sGC)- cyclic guanosine monophosphate (cGMP) contributing in vasodilation, reperfusion and oxygen delivery. Literatures review focusing on NO/sGC/cGMP pathway was performed as well as seeking themolecular biology aspects inKyoto Encyclopedia of genes and genomes (KEGG). NO is an important signaling molecule activating sGC and cGMP production, which is a mediator of vasodilation and platelet inhibition. Considering the subject, it could be hypothesized that the application of sGC stimulators and activators is a very curious strategy for pressure ulcer healing. It is well known that pressure and shear forces usually produce the blood vessel obstruction, inducing ischemia and tissue necrosis and in pathologic states, damaged endothelium leads to a reduced synthesis of NO and inadequate oxygen supply contributing to delayed wound healing. Riociguat is the first FDA approved agent of new class of sGC stimulators, involving in activation of sGC both in presence and absence of NO. The findings of this review confirm that Riociguat could start a new therapeutic approach for pressure ulcer treatment even with dysfunctional endothelium.

A Descriptive, Retrospective Study of Using an Oblique Downward-design Gluteus Maximus Myocutaneous Flap for Reconstruction of Ischial Pressure Ulcers

Despite advances in reconstruction techniques, ischial pressure ulcers continue to present a challenge for the plastic surgeon. The purpose of this retrospective study was to evaluate outcomes of using an oblique downward gluteus maximus myocutaneous (GMM) flap for coverage of grade IV ischial ulcers. Data regarding defect size, flap size, operation time, duration of wound healing, and surgical outcome were abstracted from the medical records of patients whose ischial pressure ulcers had been reconstructed using GMM island flaps between January 2010 and December 2015. The 22 patients comprised 15 men and 7 women with a mean age of 52 (range 16-81) years. Twenty (20) had paraplegia, 6 had a recurrent ischial ulcer, 2 were bedridden following a cerebrovascular accident, 1 had a myelomeningocele status post operation, and 19 were spinal cord injury patients. Follow-up time ranged from 6 to 40 months. Pressure ulcer size ranged from 3 cm x 2 cm to 10 cm x 5 cm (average 22.3 cm2). The average flap size was 158 cm2 (15.9 cm x 9.7 cm); the largest was 286 cm2 (22 cm x 13 cm). The operating time ranged from 52 minutes to 110 minutes (average, 80 minutes). In 2 cases, wound dehiscence occurred but completely healed after resuturing. One (1) ischial pressure ulcer recurred 6 months following surgery and was successfully covered with a pedicled anterolateral thigh flap. No recurrences or problems were observed in the remaining 20 patients. Time to complete wound healing ranged from 14 to 24 days (average 17.8 days). Treatment of ischial pressure ulcers with GMM flaps allowed for an easy, simple procedure that provided the adequate thickness of soft tissue needed to cover the bony prominence, fill dead space, and cover the lesion. This technique was a reliable and safe reconstructive modality for the management of ischial pressure ulcers, even in recurrent cases.

Comparative study between fasciocutaneous and myocutaneous flaps in the surgical treatment of pressure ulcers of the sacral region

IntroductionDecubitus ulcers of the sacral region are common conditions in bedridden patients. Deep lesions (Stages III and IV) often require surgical treatment for closure. Flaps of the region are the first choice for treatment. We present our experience in the treatment of these lesions and compare two different approaches: local fasciocutaneous flap and gluteus maximus myocutaneous flap with V-Y advancement. MethodFrom March 2009 to May 2014, 32 patients underwent closure of sacral pressure ulcers by flaps, 17 of them with rotational local fasciocutaneous flaps and 15 with myocutaneous flaps of the gluteus maximus muscle with V-Y advancement. Evolution regarding complications and rate of success after two months was compared between the groups. ResultsOut of the 32 operated patients we obtained resolution of lesions after two months in 23 (71.8%), 10 patients in the fasciocutaneous flap group (58.8%) and 13 cases in the myocutaneous flap group (86.6%). The most common complication was partial dehiscence of sutures in 12 patients (37.5%), 8 patients in the fasciocutaneous flap group (47%) and 4 patients in the myocutaneous flap group (26.6%). The group of patients reconstructed with local fasciocutaneous flaps presented 3 cases with seroma, one with hematoma and 6 with partial cutaneous necrosis; these patients also required more drainage time. ConclusionsBoth the local rotational fasciocutaneous flap and the myocutaneous flap of the gluteus maximus muscle in V-Y flap can be used in the surgical treatment of sacral ulcers. In our experience, a reduced success rate and more complications were found in the local fasciocutaneous reconstructive method.

Interventions for pressure ulcers: a summary of evidence for prevention and treatment.

Narrative review. Pressure ulcers are a common complication in people with reduced sensation and limited mobility, occurring frequently in those who have sustained spinal cord injury. This narrative review summarises the evidence relating to interventions for the prevention and treatment of pressure ulcers, in particular from Cochrane systematic reviews. It also aims to highlight the degree to which people with spinal cord injury have been included as participants in randomised controlled trials included in Cochrane reviews of such interventions. Global. The Cochrane library (up to July 2017) was searched for systematic reviews of any type of intervention for the prevention or treatment of pressure ulcers. A search of PubMed (up to July 2017) was undertaken to identify other systematic reviews and additional published trial reports of interventions for pressure ulcer prevention and treatment. The searches revealed 38 published systematic reviews (27 Cochrane and 11 others) and 6 additional published trial reports. An array of interventions is available for clinical use, but few have been evaluated adequately in people with SCI. The effects of most interventions for preventing and treating pressure ulcers in people with spinal cord injury are highly uncertain. Existing evaluations of pressure ulcer interventions include very few participants with spinal cord injury. Subsequently, there is still a need for high-quality randomised trials of such interventions in this patient population.

Chitosan Gel to Treat Pressure Ulcers: A Clinical Pilot Study.

Chitosan is biopolymer with promising properties in wound healing. Chronic wounds represent a significant burden to both the patient and the medical system. Among chronic wounds, pressure ulcers are one of the most common types of complex wound. The efficacy and the tolerability of chitosan gel formulation, prepared into the hospital pharmacy, in the treatment of pressure ulcers of moderate severity were evaluated. The endpoint of this phase II study was the reduction of the area of the lesion by at least 20% after four weeks of treatment. Thus, 20 adult volunteers with pressure ulcers within predetermined parameters were involved in a 30 days study. Dressing change was performed twice a week at outpatient clinic upon chronic wounds management. In the 90% of patients involved in the study, the treatment was effective, with a reduction of the area of the lesion and wound healing progress. The study demonstrated the efficacy of the gel formulation for treatment of pressure ulcers, also providing a strong reduction of patient management costs.