Sacral and ischial pressure ulcers: evaluation, treatment, and differentiation.

Although the cost of caring for pressure ulcers is enormous, few accepted standards of care exist in the fragmented specialty of wound care. This review attempts to establish a standardized approach to the evaluation and treatment of sacral and ischial wounds, and to describe some important differences. Topics reviewed include important elements of the history, physical, and laboratory studies of patients with wounds. Treatment issues are also addressed including wound care, pressure relief, and nutrition. The authors hope that the principles discussed will stimulate caregivers to examine their practices, and will serve as a starting point for formation of more exacting accepted care. While each patient and wound may require subtle nuances of care in certain areas, a more uniform set of standards will be the first step in creating delivery systems that are geared for large-scale prospective randomized studies that are so desperately needed in most areas of wound care.