Epidemiology and risk factors of pressure ulcers

Pressure ulcers really are a major health care problem costing vast amounts of money annually. Patients could be classified into two groups: insensate (denervated ulcers) or sensate (innervated ulcers). The main risk factor for that patients in the first group is inadequate reposition and turning. A history of a previous pressure sore is also a significant risk factor.

Roughly 60% of spinal cord injury patients will develop a pressure ulcer throughout their lifetime. Sensate patients also develop pressure sores due to prolonged pressure. The patients at the highest risk are elderly with femoral neck fractures, of which 65% will develop a pressure ulcer. Other high risk groups include ICU patients, burn patients and elderly residents of long-term care facilities, of which about 20-30% will build up a pressure sore.

Among the sensate patients, risk factors include a low ratio of staff to patients, infrequent turning, prolonged immobility, poor nutritional status, significant weight reduction, utilization of catheters and also the required utilization of positioning devices.

Pathophysiology

Pressure ulcers come from continual pressure that exceeds the standard capillary pressure (20-32 mm Hg) for a period of time that is sufficient to cause tissue death. Relieving pressure for a few minutes every hour will save the tissue from dying. The duration required for cell death to happen is variable, ranging from 4 hours for muscle to 12 hours for skin.

Nevertheless, most authorities agree that continual pressure for more than 2 hours will result in severe tissue damage, especially if it has recently been subjected to prolonged ischemia. Shearing forces and other factors also play a role in pressure sore formation.

Pressure sores occur characteristically over bony prominences, in which the overlying soft tissue is compressed between your bone along with a firm surface. Normally, people reposition themselves with plenty of frequency; however , if patients are insensate or incapable of repositioning, there's a risk of creating a pressure sore. The first stages of the pressure ulcer begin with erythema and then ulceration of your skin. If proper wound care and pressure relieving measures aren't taken, the ulcer will progress.

Pressure Ulcer Description

When describing a pressure ulcer, the next points should be addressed:

The anatomic location from the pressure ulcer
The depth of the ulce
The dimensions of the ulcer and also the presence of sinus tracts
Whether there is proof of infection
Be it clean (pink-red) or necrotic (black or white)
When there is evidence of scars from prior flaps or from healing by secondary intention

Common Sites of Occurrence

Pressure ulcers can be cultivated over any bony prominence. There are four areas that encompass the majority of the pressure sores seen by plastic surgeons:

Ischium-due to prolonged pressure in the sitting position
Trochanter-due to prolonged pressure in the lateral decubitus position
Sacrum-due to prolonged pressure in the supine position
Calcaneus and occiput-due to prolonged pressure in the supine position

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