Pressure Injuries (Pressure Ulcers) and Wound Care Questions & Answers

Updated: Mar 26, 2020
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Questions & Answers

Overview

What are pressure injuries (pressure ulcers)?

What is the focus of history for pressure injuries (pressure ulcers)?

Why is a general physical exam needed in the evaluation of suspected pressure injuries (pressure ulcers)?

How are pressure injuries (pressure ulcers) staged?

What are possible complications of ulcerated pressure injuries (pressure ulcers)?

What is the role of lab studies in the diagnosis of pressure injuries (pressure ulcers)?

When are lab studies indicated in the workup of pressure injuries (pressure ulcers)?

Which imaging studies and procedures may be helpful in the diagnosis of pressure injuries (pressure ulcers)?

What are the general principles of wound assessment and treatment for pressure injuries (pressure ulcers)?

How are pressure injuries (pressure ulcers) treated?

How is medical status optimized prior to surgery for the treatment of pressure injuries (pressure ulcers)?

What are nonsurgical options in the treatment of pressure injuries (pressure ulcers)?

What surgical options for the treatment of pressure injuries (pressure ulcers)?

What are the options for surgical closure of pressure injuries (pressure ulcers)?

How is a reconstruction approach selected for pressure injuries (pressure ulcers)?

How are pressure injuries (pressure ulcers) prevented?

What are other names used for pressure injuries (pressure ulcers)?

What are the National Pressure Ulcer Advisory Panel (NPUAP) and the National Pressure Injury Advisory Panel (NPIAP)?

How are pressure injuries (pressure ulcers) defined?

How do pressure injuries (pressure ulcers) develop?

What are risk factors for pressure injuries (pressure ulcers)?

Why are pressure injuries (pressure ulcers) a national healthcare issue?

What is involved in the management of pressure injuries (pressure ulcers)?

How are pressure injuries (pressure ulcers) prevented?

What are therapeutic modalities used in the treatment of pressure injuries (pressure ulcers)?

Why is research in the area of secondary prevention of pressure injuries (pressure ulcers) needed?

Which research questions need to be addressed regarding pressure injuries (pressure ulcers)?

What are the National Pressure Ulcer Advisory Panel (NPUAP) recommended research priorities for pressure injuries (pressure ulcers)?

Which methodologic and policy issues associated with pressure injuries (pressure ulcers) require investigation?

Where are pressure injuries (pressure ulcers) most likely to occur on the body?

What tissue levels are involved in pressure injuries (pressure ulcers)?

What is the pathogenesis of pressure injuries (pressure ulcers)?

How do pressure injuries (pressure ulcers) become ulcerated?

What are the ranges of pressure that can cause pressure injuries (pressure ulcers)?

What are important components of the mechanism of injury by pressure injuries (pressure ulcers)?

What is the order of tissue damage in pressure injuries (pressure ulcers)?

What is the role of reperfusion in pressure injuries (pressure ulcers)?

What is the most common cause of pressure injuries (pressure ulcers)?

What is the role of contractures and spasticity in the etiology of pressure injuries (pressure ulcers)?

What role of pain in the etiology of pressure injuries (pressure ulcers)?

What is the role of skin quality in the etiology of pressure injuries (pressure ulcers)?

What is the role of incontinence in the etiology of pressure injuries (pressure ulcers)?

Which factor increases the mortality risk of pressure injuries (pressure ulcers)?

Which factors inhibit healing of pressure injuries (pressure ulcers)?

Which patient groups are at increased ricks for pressure injuries (pressure ulcers)?

What is the incidence of pressure injuries (pressure ulcers) in the US?

What is the overall prevalence of pressure injuries (pressure ulcers) in hospital settings in the US?

What is the incidence of pressure injuries (pressure ulcers) among elderly persons in the US?

What is the prevalence of pressure injuries (pressure ulcers) in nursing homes in the US?

What is the incidence and mortality rate of pressure injuries (pressure ulcers) in patients with spinal cord injury (SCI)?

Why are patients with spinal cord injury (SCI) at increased risk of pressure injuries (pressure ulcers)?

Why are blacks with SCI at increased risk for pressure injuries (pressure ulcers)?

What is the global prevalence of pressure injuries (pressure ulcers)?

How does the prevalence of pressure injuries (pressure ulcers) vary by age?

How does the incidence of pressure injuries (pressure ulcers) vary by sex?

What are the racial predilections of pressure injuries (pressure ulcers)?

What is the mortality rate for pressure injuries (pressure ulcers)?

What are the common causes of fatality from chronic pressure injuries (pressure ulcers)?

What is the most common complication of pressure injuries (pressure ulcers)?

Which infectious agents are commonly isolated in pressure injuries (pressure ulcers)?

How is bacteremia managed in patients with pressure injuries (pressure ulcers)?

What is the incidence of bacteremia in elderly patients with pressure injuries (pressure ulcers)?

When is consultation with an infectious disease specialist indicated in the treatment of pressure injuries (pressure ulcers)?

What is the role of osteomyelitis in the progression of pressure injuries (pressure ulcers)?

How is osteomyelitis diagnosed in patients with pressure injuries (pressure ulcers)?

How is osteomyelitis managed in patients with pressure injuries (pressure ulcers)?

What are possible complications of pressure injuries (pressure ulcers)?

What information about pressure injuries (pressure ulcers) should patients and caregivers receive?

Presentation

What are the signs and symptoms of pressure injuries (pressure ulcers)?

What should be the focus of history in the evaluation of pressure injuries (pressure ulcers)?

What should be the focus of history of a current pressure injury (pressure ulcers)?

What systematic symptoms should be reviewed during the evaluation of pressure injuries (pressure ulcers)?

Why is a thorough physical exam necessary for patients with pressure injuries (pressure ulcers)?

How should the wound be examined in patients with pressure injuries (pressure ulcers)?

What is the severity of a pressure injury (pressure ulcers) defined?

What is the National Pressure Injury Advisory Panel (NPIAP) staging system for pressure injuries (pressure ulcers)?

What should be assessed in the physical exam of pressure injuries (pressure ulcers)?

How are complications of pressure injuries (pressure ulcers) categorized?

What are the complications of chronic pressure injuries (pressure ulcers)?

What is the most serious complication of chronic pressure injuries (pressure ulcers)?

What are the histological findings indicative of malignant transformation of pressure injuries (pressure ulcers)?

How are Marjolin ulcers due to pressure injuries (pressure ulcers) treated?

What is the prevalence of malignant transformation of pressure injuries (pressure ulcers)?

What are the signs and symptoms of autonomic dysreflexia due to pressure injuries (pressure ulcers)?

What is the most common precipitating cause of autonomic dysreflexia in pressure injuries (pressure ulcers)?

What is the treatment for osteomyelitis due to pressure injuries (pressure ulcers)?

What is the treatment for pyarthrosis due to pressure injuries (pressure ulcers)?

What is the treatment of sepsis in patients with pressure injuries (pressure ulcers)?

What is the treatment for urethral fistula due to pressure injuries (pressure ulcers)?

Workup

How is a complete blood count (CBC) used for the diagnosis of pressure injuries (pressure ulcers)?

Which lab tests are useful in the evaluation of pressure injuries (pressure ulcers)?

Which lab studies are performed in diagnosis of pressure injuries (pressure ulcers) based on a specific clinical situation?

What is the role of imaging studies in the diagnosis of pressure injuries (pressure ulcers)?

What is the role of tissue biopsy in the diagnosis of pressure injuries (pressure ulcers)?

What is the role of tissue biopsy in the management of chronic pressure injuries (pressure ulcers)?

What is the role of bone biopsy in the diagnosis of pressure injuries (pressure ulcers)?

Which histologic findings are characteristic of pressure injuries (pressure ulcers)?

Treatment

What are treatment options for pressure injuries (pressure ulcers)?

What are the general principles of assessment and treatment of pressure injuries (pressure ulcers)?

What are the goals of medical management of pressure injuries (pressure ulcers)?

What medical treatment must be completed prior to surgical reconstruction for pressure injuries (pressure ulcers)?

When is wound reconstruction considered as a treatment for pressure injuries (pressure ulcers)?

Which patient groups are not good candidates for surgical reconstruction of pressure injuries (pressure ulcers)?

Which promising treatment options are being studied for pressure injuries (pressure ulcers)?

What is included in the discharge planning of patients with pressure injuries (pressure ulcers)?

When should less aggressive treatment for pressure injuries (pressure ulcers) be considered?

How is spasticity in pressure injuries (pressure ulcers) controlled?

Why is it important to optimize nutritional status in patients with pressure injuries (pressure ulcers)?

What are the goals of nutritional support in patients with pressure injuries (pressure ulcers)?

What steps should be taken to prevent vasoconstriction in pressure injuries (pressure ulcers)?

How should urinary and fecal incontinence be managed in patients with pressure injuries (pressure ulcers)?

How is bacterial infection managed in pressure injuries (pressure ulcers)?

How should wound healing be assessed in patients with pressure injuries (pressure ulcers)?

What is the role of pressure reduction in the management of pressure injuries (pressure ulcers)?

How are bedbound patients monitored to reduce the development of pressure injuries (pressure ulcers)?

How is pressure reduction achieved in the treatment of pressure injuries (pressure ulcers)?

What are the support surfaces used for pressure reduction in patients with pressure injuries (pressure ulcers)?

What special cushions may be used in the prevention of pressure injuries (pressure ulcers)?

Which clinical trials have been performed to evaluate the effectiveness of specialized support surfaces for prevention of pressure injuries (pressure ulcers)?

Which support surface is most effective in the prevention of pressure injuries (pressure ulcers)?

What is the efficacy of foam mattresses for the prevention of pressure injuries (pressure ulcers)?

What is the basis for selection of support surfaces for prevention of pressure injuries (pressure ulcers)?

When are pressure-reducing devices indicated for the prevention of pressure injuries (pressure ulcers)?

What guidelines are available for the management of existing pressure injuries (pressure ulcers)?

What care is given following débridement of pressure injuries (pressure ulcers)?

What are the débridement procedures used in the treatment of pressure injuries (pressure ulcers)?

What is the role of povidone-iodine solution in the treatment of pressure injuries (pressure ulcers)?

What is the goal of wound cleansing in patients with pressure injuries (pressure ulcers)?

How is povidone-iodine used in the treatment of pressure injuries (pressure ulcers)?

What is the role of acetic acid in the treatment of pressure injuries (pressure ulcers)?

What is the role of sodium hypochlorite in the treatment of pressure injuries (pressure ulcers)?

What are the wound dressing options for the treatment of pressure injuries (pressure ulcers)?

How are hydrocolloid dressings used in the treatment of pressure injuries (pressure ulcers)?

How are gel dressings used in the treatment of pressure injuries (pressure ulcers)?

How are transparent adhesive dressings used in the treatment of pressure injuries (pressure ulcers)?

How are alginate dressings used in the treatment of pressure injuries (pressure ulcers)?

How are wet-to-dry dressings used in the treatment of pressure injuries (pressure ulcers)?

How are vacuum-assisted closure (VAC) sponges used in the treatment of pressure injuries (pressure ulcers)?

How should wound dressings be applied in the treatment of pressure injuries (pressure ulcers)?

What is the role of topical antibiotics in the treatment of pressure injuries (pressure ulcers)?

What is the role of mafenide in the treatment of pressure injuries (pressure ulcers)?

What is an algorithmic approach to evaluation of pressure injuries (pressure ulcers)?

What are the limitations of antibiotics in the treatment of pressure injuries (pressure ulcers)?

How are immunocompromised patients with pressure injuries (pressure ulcers) managed?

Which factors should be considered prior to initiating antibiotics to treat pressure injuries (pressure ulcers)?

Which therapeutic methods are being evaluated for the treatment of chronic pressure injuries (pressure ulcers)?

What is the role of becaplermin in the treatment of pressure injuries (pressure ulcers)?

What is the role of negative-pressure wound therapy (NPWT) in the treatment of pressure injuries (pressure ulcers)?

What are the indications for negative-pressure wound therapy (NPWT) in the treatment of pressure injuries (pressure ulcers)?

What are the contraindications for negative-pressure wound therapy (NPWT) in the treatment of pressure injuries (pressure ulcers)?

What are the goals of débridement in the treatment of pressure injuries (pressure ulcers)?

When is surgery indicated for pressure injuries (pressure ulcers)?

When is urinary or fecal diversion indicated in the treatment of pressure injuries (pressure ulcers)?

How are flexion contractures managed in patients with pressure injuries (pressure ulcers)?

What are the goals of reconstruction in patients with pressure injuries (pressure ulcers)?

How is reconstruction performed for pressure injuries (pressure ulcers)?

What is the process of surgical débridement for the treatment of pressure injuries (pressure ulcers)?

What are the options for wound closure in patients with pressure injuries (pressure ulcers)?

What preoperative care is needed to ensure successful surgical management of pressure injuries (pressure ulcers)?

What is the role of oxidative stress in the etiology of pressure injuries (pressure ulcers)?

What is the importance of patient positioning in the surgical management of pressure injuries (pressure ulcers)?

What should be included in postoperative care of pressure injuries (pressure ulcers)?

What are the disadvantages of direct wound closure of pressure injuries (pressure ulcers)?

What are the disadvantages of skin grafts for pressure injuries (pressure ulcers)?

How are skin flaps used in the treatment of pressure injuries (pressure ulcers)?

How are myocutaneous flaps used in the treatment of pressure injuries (pressure ulcers)?

How are free flaps used in the treatment of pressure injuries (pressure ulcers)?

How are trochanteric pressure injuries (pressure ulcers) repaired?

How are muscle pressure injuries (pressure ulcers) repaired?

How is the reconstruction approach selected for pressure injuries (pressure ulcers)?

What is the most common site of pressure injuries (pressure ulcers) in individuals with paraplegia?

What are the limitations to an inferior gluteal myocutaneous flap for the treatment of pressure injuries (pressure ulcers)?

What options for ischial reconstruction of pressure injuries (pressure ulcers)?

How are sacral pressure injuries (pressure ulcers) managed?

How are sacral pressure injuries (pressure ulcers) reconstructed?

What is a superior gluteal myocutaneous flap for sacral pressure injuries (pressure ulcers)?

What anatomy is involved in repair of sacral pressure injuries (pressure ulcers)?

How is the superior portion of the gluteus maximus used in the reconstruction of sacral pressure injuries (pressure ulcers)?

What are the reconstruction limitations of sacral pressure injuries (pressure ulcers)?

What is required for the reconstruction of larger sacral pressure injuries (pressure ulcers)?

Why is release of the gluteal muscle important in the reconstruction of sacral pressure injuries (pressure ulcers)?

What are the goals of postoperative care following reconstruction of pressure injuries (pressure ulcers)?

What is included in initial postoperative care following reconstruction of pressure injuries (pressure ulcers)?

What is included in postoperative care 6 weeks after surgery for pressure injuries (pressure ulcers)?

What skin care is needed following surgery for pressure injuries (pressure ulcers)?

What is the benefit of transfer to a subacute or rehabilitation facility following surgery for pressure injuries (pressure ulcers)?

What are the possible complications reconstructive surgery for pressure injuries (pressure ulcers)?

What measures should be taken to minimize the risk of adverse outcomes of the reconstruction of pressure injuries (pressure ulcers)?

What is the likelihood of recurrence of pressure injuries (pressure ulcers)?

What are the activity modifications following surgery for pressure injuries (pressure ulcers)?

What are the activity modifications following surgery for ischial tuberosity pressure injuries (pressure ulcers)?

How success is prevention of pressure injuries (pressure ulcers)?

What is the Wound, Ostomy, and Continence Nurses Society (WOCN) definition of unavoidable pressure injuries (pressure ulcers)?

What are the components of prevention of pressure injuries (pressure ulcers)?

What are the risk factors for the formation of pressure injuries (pressure ulcers)?

What are the predictive factors of pressure injuries (pressure ulcers)?

Which assessment tools are used to assess risk for pressure injuries (pressure ulcers)?

What are the Agency for Health Care Policy and Research (AHCPR) guidelines for risk assessment of pressure injuries (pressure ulcers)?

Which patient groups are at highest risk of developing pressure injuries (pressure ulcers)?

What are secondary risk factors for pressure injuries (pressure ulcers)?

Which organization has issued guidelines on preventing pressure injuries (pressure ulcers)?

What are the elements of a comprehensive care plan for effective prevention or pressure injuries (pressure ulcers)?

What are the specific details that should be included in an intervention to prevent pressure injuries (pressure ulcers)?

What institutional steps can be taken to reduce the prevalence of pressure injury (pressure ulcer)?

Which specialist consultations are needed for management of pressure injuries (pressure ulcers)?

How often should follow-up be performed after treatment of pressure injuries (pressure ulcers)?

How is the healing of pressure injuries (pressure ulcers) monitored?

How is wound healing promoted in an outpatient setting in patients with pressure injuries (pressure ulcers)?

What is the role of home healthcare in the treatment of pressure injuries (pressure ulcers)?

Guidelines

What are the ACP guidelines for prevention, and treatment of pressure injuries (pressure ulcers)?

What are the AHCPR guidelines for managing existing pressure injuries (pressure ulcers)?

What are WOCN guidelines for the prevention of pressure injuries (pressure ulcers)?

What are the WOCN treatment guidelines for pressure injuries (pressure ulcers)?

Medications

What is the role of medications in the treatment of pressure injuries (pressure ulcers)?

Which medications in the drug class Antibiotics are used in the treatment of Pressure Injuries (Pressure Ulcers) and Wound Care?

Which medications in the drug class Skeletal Muscle Relaxants (Direct Acting) are used in the treatment of Pressure Injuries (Pressure Ulcers) and Wound Care?

Which medications in the drug class Skeletal Muscle Relaxants (Centrally Acting) are used in the treatment of Pressure Injuries (Pressure Ulcers) and Wound Care?