Skin problems health centre

Your care team

As pressure ulcers are a complex health problem, arising from many inter-related factors, your care may be provided by a care team made up of many different types of health professionals. This type of team is sometimes known as a multi-disciplinary team (MDT).

Possible members of a MDT may include:

• nurses,
• an incontinence advisor,
• a social worker,
• a physical therapist,
• a dietitian,
• a urologist (a doctor who specialises in treating conditions that affect the urinary system),
• a gastroenterologist (a doctor who specialises in treating conditions that affect the bowel),
• a plastic surgeon,
• a orthopaedic surgeon (a surgeon who specialises in the treatment of conditions that affect the joints and bones), and
• a neurosurgeon (a surgeon who specialises in the treatment of conditions that affect the brain and nervous system).

Changing position

Regularly moving your body and changing your position is one of the best ways to prevent pressure ulcers developing, and relieving pressure on grade one and grade two pressure ulcers.

Once your risk assessment has been completed, your care team will draw up a 'repositioning timetable' which will state how often you need to be moved. For some people, this may be as often as once every 15 minutes, while others may need to be moved only once every two hours.

A nurse or physical therapist may also give you training and advice about:

• correct sitting and lying positions,
• how you can adjust your sitting and lying position,
• how often you need to move or be moved,
• how best to support your feet,
• how to keep a good posture, and
• the special equipment that you should use and how to use it.

Mattresses and cushions

A range of special mattresses and cushions are available that can be used to relieve pressure on vulnerable parts of the body. Your care team will discuss what types of mattresses and cushions are best for you.

People who are thought to be at risk of developing pressure ulcers, or who have pre-existing grade one or two pressure ulcers usually benefit from resting on a specially designed foam mattress which relieves the pressure on their body.

People with a grade three, or four, pressure ulcer will require a more sophisticated mattress, or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated in order to reduce pressure as and when required.

Dressings

Specially designed dressings and bandages are available that can be used to protect pressure ulcers and speed up the healing process.

Examples of these types of dressing include:

• hydrocolloid dressings - which are dressings that contain a special gel that encourages the growth of new skin cells in the ulcer while keeping the surrounding area healthy skin dry, and
• alginate dressings - which are dressings that are made from seaweed and contain sodium and calcium, which are known to speed up the healing process.

Topical preparations

Topical preparations, such as cream and ointments, can be used to help speed up the healing process while also preventing further tissue damage. A type of chemical, known as oxygen-free radical scavengers, can help prevent cell damage at the genetic level.

Antibiotics

If you have a pressure ulcer, you may be given antibiotics to prevent them becoming infected by bacteria and, as a precaution, to prevent a secondary infection developing.

Antiseptic cream may also be applied directly to any pressure ulcers to clear out any bacteria that may be present.

Nutrition

Certain dietary supplements, such as protein, zinc, and vitamin C have been shown to accelerate wound healing. If your diet lacks these vitamins and minerals, your skin may become more vulnerable to the development of pressure ulcers.

As a result of this, you may be referred to a dietitian so that a suitable dietary plan can be drawn up for you.

Debridement

In some cases, it may be necessary to remove dead tissue from the ulcer in order to stimulate the healing process. This is known as debridement.

If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste.

Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include:

• cleansing and pressure irrigation - where dead tissue is removed using high-pressure water jets,
• ultrasound - where dead tissue is removed using low-frequency energy waves, and
• laser - where dead tissue is removed using focused beams of light.

Maggot therapy

Maggot therapy - also known as larvae therapy - is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help fight infection by releasing substances that kill bacteria and stimulate the healing process.

During maggot therapy, the maggots are mixed into a wound dressing and the area is then covered with gauze. After a few days, the dressing is taken off and the maggots are removed.

Surgery

Sometimes, it may not be possible for a grade 3, or grade 4, pressure ulcer to heal, and surgery will be required to seal the wound and prevent any further tissue damage occurring.

A widely used surgical technique for the treatment of pressure ulcers is known as flap replacement (sometimes referred to as flap reconstruction). During this technique, the surgeon will use a scalpel to debride the ulcer of dead tissue. A flap of skin and muscle is then taken from another part of the body and is used to seal the site of the ulcer.

Flap replacement  surgery can be challenging, and it is often made more difficult by the fact that most people who undergo the procedure are already in a poor state of health. As a result of these risk factors, there are a large number of possible complications that can arise after surgery including:

• infection,
• tissue death of the implanted flap
• muscle weakness,
• blisters,
• recurrence of the pressure ulcers,
• blood infection,
• infection of the bone,
• internal bleeding,
• abscesses, and
• deep vein thrombosis.

Despite the high risk of complications, surgery is often a clinical necessity in order to prevent life-threatening complications of pressure ulcers developing, such as blood poisoning, or gangrene.