Pressure sores

Pressuresoresor decubitusulcers areaseriousproblemfor thehospitalized or homeboundbedriddenpatient. The incidenceof this problemranges from three to elevenpercent. Complicationsofpressuresoresincludeosteomyelitisand sepsiswith the mortality rateof sepsisapproaching50percent.1 Wilkes,2 in 1974,reportedbedsoresasoneofthetenmajorsymptoms after admissionin 296 terminally ill patientsbeing cared for in a small hospice-likeunit in England.Because ofthechronicityof thehospicepatient, the occurrenceof pressuresorescan adverselyinfluencethe quality of life and,thus, preventionof thisproblemis of upmostimportance. Of interest, asnotedby Reulerand Cooney,3the term decubitusulcer, which is derivedfrom the Latin word ducubmeaning“lying down,” is often used to describethis problem. However, this is a misnomersince a large numberof thesesoresdevelop while thepatientis inasittingposition. Therefore,the term pressuresore shouldbe usedbecauseit is moreaccurate and describesthe underlying pathophysiology. Althoughtherearemanycontributing factorstothedevelopment of pressuresores,fourhavebeenidentifiedas critical: pressure,shearingforces,friction, andmoisture.3Pressureis theessentialelement.In the skin, thenormal internal capillary pressureis 32 mm Hg. Whenexternalpressuresgreater thanthis amountareapplied,the skin capillaries as well as the lymphatics collapseleadingto significantdisruption of bloodandlymphatic flow. The netresultof thisheightenedpressureis time dependent. A pressureof 70 mm Hg applied for more thantwo hours producesirreversible tissuedamage,