Dressings and topical agents to treat the pressure ulcers
Bedsores (also called pressure ulcers or decubitus ulcers) are injuries of the skin and underlying tissue, resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as heels, ankles, hips and tailbone.
The most common sites are: sacrum, coccyx, heels, hips, elbows, knees, ankles, back of shoulders and the back of the cranium. For people who use a wheelchair, pressure sores often occur on skin over the following sites: tailbone or buttocks, shoulder blades and spine, back of arms and legs
Pressure ulcers have a large impact on those aJected; the ulcers can be painful and may become seriously infected or malodorous. There are numerous and diverse dressings available for treating pressure ulcers and their properties are described below.
- Stage I: Intact skin with redness in a localized area usually over a bony prominence. Its colour, thickness and temperature, is usually different compared to adjacent tissue.
- Stage II: Partial thickness tissue loss presenting open ulcer with a red-pink wound bed, without slough or open/ruptured serum-filled blister.
- Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscles are not exposed.
- Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed.
- Unstageable: Full thickness tissue loss in which the actual depth of the ulcer is completely obscured by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the wound bed. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels is normally protective and should not be removed.
- Deep Tissue Pressure Injury: Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discolouration or epidermal separation revealing a dark wound bed or blood-filled blister.
The diversity of dressings and related materials available to health professionals for treating pressure ulcers makes evidence based decision-making difficult when determining the optimum treatment regimen for a particular patient.
Westby MJ and Coll have successfully conducted a network meta-analysis of dressings and topical agents for healing pressure ulcers. This review includes 51 RCTs involving a total of 2964 participants, comparing 39 different dressings or topical agents for the healing of pressure ulcers.
There is currently insufficient evidence to judge whether any one dressing or topical treatment increases the probability of pressure ulcer healing compared with others. Based on current evidence, decision-makers may wish to make wound dressing choices on the basis of wound symptoms, clinical experience, patient preference and cost.