Pressure sore

Disease Description (Causes and Symptoms)

• Definition: An ulcerative skin injury (pressure ulcer) in which persistent pressure reduces blood flow to the affected area, causing ischemia and necrosis of the skin, subcutaneous fat, and muscles.
• Causes/pathophysiology: Prolonged pressure, shear forces, friction, and moisture (such as urinary incontinence) combine to block the supply of oxygen and nutrients to tissues, leading to tissue necrosis. The risk is higher in areas with bony prominences (sacrum, ischial tuberosity, greater trochanter, knees, heels, etc.).
• Main symptoms: Localized redness (persisting even after pressure is removed), pain (varies by stage), blisters/skin breakdown, necrosis (black discoloration and foul-smelling discharge), swelling, changes in skin color, and skin fissures.
• Stages (brief summary):
  • Stage 1: Non-blanchable redness without surface skin damage; the skin is warm and firm. Recovery may be possible within 1 day to 1 week.
  • Stage 2: Partial damage to the epidermis and dermis (abrasion or blister). Recovery may be possible within 5 days to 3 months.
  • Stage 3: Necrosis of subcutaneous tissue and exudate; pain may decrease. Healing takes 1 to 6 months.
  • Stage 4: Extensive necrosis extending to the muscles, bones, tendons, and joints; surgery is required. Treatment takes 6 months to more than 1 year.
• Complications: Local infection, cellulitis, osteomyelitis, bacteremia, and sepsis (which may be fatal in severe cases). The mortality rate of pressure-ulcer-related bacteremia is high.

Treatment Methods

• Basic principles: Pressure relief, infection control, removal of necrotic tissue, optimization of the wound environment, and correction of systemic conditions (such as nutrition and anemia).
• Conservative treatment
  • Pressure redistribution: Change position (at least every 1–2 hours; a 30° lateral position is recommended for high-risk individuals), and use special mattresses (low-pressure or pressure-redistributing) and cushions.
  • Skin care: Inspect at least once a day, use warm water and a mild cleanser, keep the skin dry, minimize exposure to urinary incontinence and sweat, and prevent friction and traction (using lifting techniques).
  • Dressings: Select an appropriate moist wound dressing (such as hydrocolloid, foam, or alginate) according to the wound condition. Adjust the replacement frequency according to the presence of exudate and infection.
  • Pain control: Use local and systemic analgesics.
  • Nutritional management: Supplement protein and calories; consider supplementation with vitamins and minerals (especially vitamin C and zinc).
• Infection treatment
  • Local infection: Local disinfection and antibiotic ointment (according to guidelines).
  • Deep infection (cellulitis, osteomyelitis, or suspected sepsis): Administer systemic antibiotics after wound cultures and blood tests. In cases of deep infection, imaging tests (such as MRI) and surgical treatment are necessary.
• Surgical treatment
  • Debridement: Promote healing by removing infected and necrotic tissue.
  • Skin grafting and flap surgery: When there is a large tissue defect, as in Stage 3 or 4, reconstruct the defect through plastic surgery or other procedures.
• Preventive measures (part of treatment)
  • Continuous pressure relief, keeping the skin dry and clean, appropriate nutritional supplementation, and infection prevention.
• Precautions/self-care
  • Inform the treating medical staff immediately if redness or discharge develops.
  • Change position regularly and receive instruction on minimizing friction and traction.
  • After surgery, comply with the prescribed wound care and activity restrictions.
• Emergency situations: Emergency medical care is needed if high fever, extensive redness, rapid worsening, altered consciousness, severe foul odor, or discharge of pus occurs (suspected sepsis or severe infection).

Checkpoints Before an Outpatient Visit (Including Example Questions)

• Items to prepare (recommended)
  • List of medications currently being taken (including prescription and nonprescription medications and supplements)
  • History of previous surgeries and wound treatment, and recent ward or hospitalization records
  • Wound photographs (showing the progression from onset to the present)
  • Records of position-change intervals and whether mobility aids are used
  • Diet and nutritional status (weight changes and food intake), and whether urinary incontinence is present
  • Records of changes in fever, pain, and discharge
• Information to tell the medical staff in advance during the outpatient visit
  • Recent rapid worsening of the wound, fever, or systemic symptoms (recommended)
• Example questions (it is helpful for patients to record these themselves and bring them)
  • Have there been any changes in the wound’s color, discharge, odor, or pain during the past 24–48 hours?
  • What is the usual interval between position changes, and how frequently was it actually followed?

Examples of General Questions to Ask the Doctor

• "What stage is my pressure ulcer? Based on its current condition, how long is the expected healing period?"
• "What tests are needed to check whether the wound is infected? Are cultures or imaging tests needed?"
• "Do any medications I am currently taking or conditions I have (such as diabetes or anticoagulant use) affect the treatment?"
• "What type of dressing should I use for wound care, and how often should it be changed?"
• "What nutritional supplements or supplements (protein or vitamins) do you recommend?"
• "If surgery (flap surgery or grafting) is needed, what are the risks and expected benefits?"

Examples of Disease-Specific Questions

• "Osteomyelitis (bone infection) is suspected at this site. When should MRI or bone tests (including blood tests) be performed?"
• "Could you tell me specifically which type of mattress or cushion (model/specifications) and what position-change schedule are recommended to prevent pressure ulcers?"