Pressure sores

Cadexomer-H is an iodophor similar to povidone-iodine. It is a 2-hydroxymethylene crosslinked (1-4) a-D-glucan carboxymethyl ether containing iodine. The compound is used especially for its absorbent and antiseptic properties in the management of leg ulcers and pressure sores where it is applied in the form of microbeads containing 0.9% iodine. 

Prevention is key in the management of pressure sores. Mild superficial pressure sore infections may be treated with topical antimicrobial agents. Systemic antibiotics are indicated for pressure sores associated with spreading cellulitis, osteomyelitis, or bacteremia. 

Pressures sores, also known as decubitous ulcers or bedsores, affect 1.5 to 3 million Americans annually.35 The cost of healing pressure sores can be substantial, with current estimates ranging from 2000 to 70,000 per wound.35 Although the prevalence of pressure sores is highest in long-term care facilities, 57% to 60% of new pressure sores actually develop in the hospital, most commonly in intensive-care and orthopedic patients. Elderly patients and those with spinal cord injuries are most at risk36... 

A pressure sore is a chronic wound that results from continuous pressure on the tissue overlying a bony prominence. This pressure impedes blood flow to the dermis and subcutaneous fat, resulting in tissue damage and necrosis.37,38... 

Pressure sore infections develop from breaks in skin integrity and contamination from dirty areas of close proximity. Pressure sore infections generally are polymicrobial.39... 

Approximately two-thirds of all pressure sores occur on the sacrum and heels. The remaining third occur predominately on the elbows, ankles, trochanters, ischia, knees, scapulas, shoulders, or occiput.35 Pressure sores are classified according to the extent of tissue destruction.40 The staging of pressure sores is presented in Table 70-7. 

Bacterial colonization of pressure sores is common. Because infection impairs wound healing and may require systemic antimicrobial therapy, the clinician must be able to distinguish it from colonization. Table 70-8 describes the clinical presentation of infected pressure sores. 

Tens of thousands of Americans, including 1 of every 12 persons with spinal cord injury, die each year as a result of complications relating to pressure sores.41 Most complications are infectious. The most common is osteomyelitis, which is present in approximately 38% of infected pressure sores.37 Less frequently, NF, clostridial myonecrosis, and sepsis can occur. 

The goals of therapy for infected pressure sores include resolution of infection, promotion of wound healing, and establishment of effective infection control.38... 

Careful monitoring and preventative care of high-risk patients can begin once these patients are identified. Intrinsic, or host-related, risk factors for the development of pressure sores include age greater than 75 years, limited mobility, loss of sensation, unconsciousness or altered sense of awareness, and malnutrition. Extrinsic, or environmental, risk factors include pressure, friction, shear stress, and moisture.37,42... 

Turning and repositioning the patient at least every 2 hours can reduce skin pressure and prevent pressure sores. However, because this level of care is unattainable in most hospital and nursing-home environments, multitudes of pressure-reducing mattresses have been manufactured. Although these can help to decrease pressure on susceptible areas, they do not negate the need for position changes.37,42... 

Malnutrition is a significant but reversible risk factor. High-protein diets have been shown in multiple studies to improve wound healing in patients with pressure sores.37... 

Decubitus ulcer (e.g. bed sores, pressure sores) Ulcer due to continuous pressure exerted on a particular area of skin. Often associated with bed-ridden patients... 

A pressure sore is also called a decubitus ulcer and bed sore. A classification system for pressure sores is presented in Table 47-5. Many factors are thought to predispose patients to the formation of pressure ulcers paralysis, paresis, immobilization, malnutrition, anemia, infection, and advanced age. Four factors thought to be most critical to their formation are pressure, shearing forces, friction, and moisture however, there is still debate as to the exact pathophysiology of pressure sore formation. The areas of highest pressure are generated over the bony prominences. 

Most pressure sores are colonized by bacteria however, bacteria frequently infect healthy tissue. A large variety of aerobic gram-positive and gramnegative bacteria, as well as anaerobes, are frequently isolated. 

More than 95% of all pressure sores are located on the lower part of the body. The most common sites are the sacral and coccygeal areas, ischial tuberosities, and greater trochanter. 

Stage 1 Pressure sore is generally reversible, is limited to the epidermis, and resembles an abrasion. It is best described as an irregularly shaped area of soft-tissue swelling with induration and heat... 

Pressure sores vary greatly in their severity, ranging from an abrasion to large lesions that can penetrate into the deep fascia involving both bone and muscle. 

Debridement can be accomplished by surgical or mechanical means (wet-to-dry dressing changes). Other effective therapies are hydrotherapy, wound irrigation, and dextranomers. Pressure sores should be cleaned with normal saline. 

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