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Source: Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed July 22, 2012.

  • Decubitus ulcer
  • Bed sore
  • Pressure sore

  • Damage to underlying soft tissue from pressure and/or shear.

  • Most pressure ulcers colonized by bacteria; bacteria frequently infect healthy tissue.
  • Cultures reveal polymicrobial growth:
    • Aerobic Gram-positive and Gram-negative bacteria
    • Anaerobes

  • Factors that predispose to formation of pressure ulcers:
    • Paralysis
    • Paresis
    • Immobilization
    • Malnutrition
    • Anemia
    • Infection
    • Advanced age
  • Factors critical to formation of pressure ulcers:
    • Pressure
      • Areas of highest pressure generated over bony prominences.
      • Degree and length of time important.
    • Shearing forces
    • Friction
    • Moisture
  • Exact pathophysiology of pressure ulcer formation unknown.

  • Most common among:
    • Chronically debilitated
    • Elderly
    • Spinal cord injury

  • Prevention single most important aspect in management of pressure ulcers.
    • Minimize friction and shearing forces by proper positioning.
    • Keep surface relatively free from moisture through skin care and prevention of soilage.
    • Most important factor: pressure relief, even for 5 minutes once every 2 hours

  • Immobilization in bed or wheelchair
  • Altered mental status
  • Incontinence
  • Malnutrition

  • >95% of pressure ulcers located on lower part of body.
  • Most common areas:
    • Sacral and coccygeal areas
    • Ischial tuberosities
    • Greater trochanter
  • Great variation in severity, ranging from abrasion to large lesions that can penetrate into deep fascia involving both bone and muscle.
  • Classification system in Table 1.

Table 1. Pressure Ulcer Classification

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