Pressure ulcers. What to do if preventive management fails.

Tissue breakdown is a direct response to external pressure, friction, or shear. The key to management of pressure ulcers is prevention. With good nursing care, as well as education of medical personnel, the patient, and family members, such lesions should rarely occur. The axioms of treatment are to remove all pressure, debride necrotic tissue, keep the ulcer clean, and prevent further injury. There is only empirical evidence attesting to the effectiveness of the various dressings and physical and topical agents used in treatment. Most pressure ulcers can be classified as grade I or II and healed by conservative measures; however, the process can be very time-consuming. Surgery is warranted for some grade III and all grade IV and V pressure ulcers and for potential complications, such as fistulas.