Your care team
Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team that is made up of different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT).
Your MDT may include:
- a tissue viability nurse (a nurse who specialises in wound care and prevention)
- a social worker
- a physical therapist
- an occupational therapist
- a dietician
- medical and surgical experts with experience in pressure ulcer management
It is important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Moving and regularly changing your position helps to:
- prevent pressure ulcers developing in vulnerable areas
- relieve the pressure on any grade one or grade two pressure ulcers that have developed
After your risk assessment is completed, your care team will draw up a ‘repositioning timetable’, which states how often you need to be moved. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two hours.
The risk assessment will also consider the most effective way to avoid putting any vulnerable areas of skin under pressure whenever possible.
A nurse or physical therapist may also give you training and advice about:
- correct sitting and lying positions
- how you can adjust your sitting and lying position
- how often you need to move or be moved
- how best to support your feet
- how to keep a good posture
- the special equipment that you should use and how to use it
Mattresses and cushions
There are a range of special mattresses and cushions that can relieve pressure on vulnerable parts of the body. Your care team will discuss the types of mattresses and cushions that are most suitable for you.
People who are thought to be at risk of developing pressure ulcers, or who have pre-existing grade one or two pressure ulcers, usually benefit from resting on a specially designed foam mattress, which relieves the pressure on their body.
People with a grade three or four pressure ulcer will require a more sophisticated mattress or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required.
Specially designed dressings and bandages can be used to protect pressure ulcers and speed up the healing process. Examples of these types of dressing include:
hydrocolloid dressings – these contain a special gel that encourages the growth of new skin cells in the ulcer while keeping dry the surrounding healthy area of skin
alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process
Topical preparations, such as cream and ointments, can be used to help speed up the healing process and also prevent further tissue damage.
If you have a pressure ulcer, you will not routinely be prescribed antibiotics. Antibiotics are usually only prescribed to treat an infected pressure ulcer and prevent the infection from spreading.
Antiseptic cream may also be applied directly to pressure ulcers to clear out any bacteria that may be present.
Certain dietary supplements, such as protein, zinc and vitamin C, have been shown to accelerate wound healing.
If your diet lacks these vitamins and minerals, your skin may be more vulnerable to developing pressure ulcers. As a result of this, you may be referred to a dietician so that a suitable dietary plan can be drawn up for you.
In some cases, it may be necessary to remove dead tissue from the ulcer to help stimulate the healing process. This procedure is known as debridement.
If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste. Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include:
cleansing and pressure irrigation – where dead tissue is removed using high-pressure water jets
ultrasound – dead tissue is removed using low-frequency energy waves
laser – dead tissue is removed using focused beams of light
surgical debridement – dead tissue is removed using surgical instruments, such as scalpels and forceps
A local anaesthetic will be used to numb the area of skin and tissue around the ulcer so that debridement does not cause any pain or discomfort.
Maggot therapy, also known as larvae therapy, is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help to fight infection by releasing substances that kill bacteria and stimulate the healing process.
During maggot therapy, the maggots are mixed into a wound dressing and the area is covered with gauze. After a few days, the dressing is taken off and the maggots are removed.
Many people may find the idea of maggot therapy off-putting but research has found that it is often more effective than more traditional methods of debridement.
Sometimes, it may not be possible for a grade three or four pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring.
Surgical treatment involves cleaning the wound and closing it by bringing together the edges of the wound (direct closure) or by using tissue moved from a nearby part of the body (flap reconstruction).
Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health. As a result of the risk factors, a large number of possible complications can occur after surgery, including:
- tissue death of the implanted flap
- muscle weakness
blisters – small pockets of fluid that develop inside the skin
- recurrence of the pressure ulcers
- blood poisoning
- infection of the bone – the medical term for this is osteomyelitis
- internal bleeding
abscesses – painful collections of pus that develop inside the body
deep vein thrombosis – a blood clot that develops inside the veins of the leg
Despite the risks, surgery is often a clinical necessity to prevent life-threatening complications of pressure ulcers developing. Such complications include blood poisoning and gangrene (the decay or death of living tissue).