Pressure Sores

Question 1

Define Pressure Sores

Answer 1

Localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or of pressure in combination with shear

Question 2

Aetiology of Pressure Sores

Answer 2

Traditionally interplay between pressure, shear, friction and moisture

Shear forces, typically generated when patients slide down in bed, may cause stretching and tearing of small blood vessels and contribute to pressure-induced damage
Role of circulation and tissue perfusion as inadequate blood flow (sepsis, hypotension, heart failure, PVD) contributes to tissue ischaemia and pressure ulceration

Question 3

Risk factors for Pressure Sores

Answer 3

Increased age
Reduced mobility 
Neurological impairment resulting in loss of sensation or paralysis 
Surgery 
Intensive care stay 
Malnourishment 
History of previous pressure ulcers
Faecal or urinary incontinence, diabetes, peripheral vascular disease

Question 4

Symptoms of Pressure Sores

Answer 4

Ulcer

• Commonly over bony prominences (but can develop anywhere)
• Small superficial wound or blisters or larger wounds, covered with necrotic tissue involving deeper tissues, including fascia, muscle or bone

Question 5

Signs of Pressure Sores on examination

Answer 5

Localised skin changes on pressure areas (Non-blanching erythema or purple or maroon localised area of discoloured intact skin)
Localised tenderness and warmth around wound area -> infection
Increased exudate and/or foul odour -> infection

Question 6

Investigations for Pressure Sores

Answer 6

Clinical diagnosis

Wound swab: if there are signs of infection

ESR: ?osteomyelitis
FBC: ?osteomyelitis - riased WCC
Serum glucose: ?DM

MRI: if there are signs of infection

Deep tissue biopsy: bony involvement is suspected