How to prevent the appearance of a pressure sore?

The 2001 French consensus conference (1) on pressure ulcer prevention provides the main actions to be performed by the healthcare team to limit the risk of pressure ulcers:

• Identify patients “at risk” requiring individual prevention and the specific factors exposing them to this risk (risk scale)
• Inspect the condition of the skin daily at the level of the bony prominences according to the patient’s position (sacrum, heel, trochanter, malleoli, elbows, occiput, etc.)
• Avoid massages on bony prominences because it does not prevent pressure sores and can, on the contrary, lead to additional tissue damage. Touch the sacrum with a peroxidized oil: Sanyrène®
• Assign to patients at risk of developing bedsores a bed and an adapted chair with a support reducing the pressure of support (mattress, mattress topper, cushion)
• Use cushions or foam wedges, to avoid direct contact of bony prominences with each other (for example, knees, heels or ankles)
• Change the patient’s position regularly, if his state of health allows it
• Minimize skin aggression related to friction and shear forces by correct positioning, transfer and repositioning techniques
• Find and eliminate sources of excessive moisture related to incontinence, sweating or wound exudates, if possible
• Plan nutritional intakes and supplements, after evaluation, in undernourished patients
• Begin rehabilitation with a view to regaining independence and walking, when the patient’s state of health improves
• Encourage patients to change their positions themselves if they can

How to treat a pressure sore?

The treatment of pressure ulcers begins with compliance with measures to prevent its aggravation and the prevention of other pressure ulcers: a patient with a pressure ulcer is at risk of developing others!

Avoid further pressure ulcers and worsening of the pressure ulcer

The patient with pressure ulcers should be changed their position every 2 to 4 hours to modify the points of support, if possible by means of lifting devices, otherwise and if this is possible with the active participation of the patient (it is necessary to suspended from a gallows above the bed) or by several people. If possible, avoid placing the patient on the pressure ulcer. If possible, use an anti-decubitus foam mattress or a forced air or water mattress (the patient rests on a canvas stretched under a flow of forced air or on a pocket filled with water), cushions and wedges. foam limiting support.

Daily physiotherapy care is necessary in patients with bedsores, allowing mobilization in bed, the fight against muscle retractions and if possible getting up, putting in a chair and resuming walking whenever possible.

In the event of malnutrition interfering with healing, doctors can use renutrition solutions rich in proteins, such as Cetornan®

Wound treatment

The wound is cleaned with tap water (if possible, the wound can be showered to remove debris) or with physiological saline. Antiseptics are only used in case of superinfection, for short periods, until the wound is clean and the skin around the pressure ulcer less inflammatory.

All the dead tissue (black, greenish, yellow, etc.) from the wound must be removed either by means of wet dressings, or by cutting up at the patient’s bed by a nurse, or even in the operating room by a surgeon for large bedsores. .

Once the pressure ulcer is clean and free of dead tissue, dressings are applied to help healing.

New treatments, most often reserved for specialized teams, sometimes provide valuable healing assistance. These are mainly VAC therapy (application of constant negative pressure to the wound), and hyperbaric oxygen therapy.

It is sometimes necessary to perform a skin graft or closure of the pressure ulcer by a surgeon if the pressure ulcer is too large

Complementary approaches

The treatment of bedsores must be carried out by a specialized team, most often in a hospital.