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The management of pressure ulers – Quality improving factor and rapid recovery strategies

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Decubitus ulcers are lesions of the skin and underlying tissue resulting from the constant, long term pressure applied to a protruding bone. Given the difficulties with treating eschars, bedsores are a classic example of “better prevent than treat”. The first step in eschar prevention is to calculate the risk for development – the Norton scale is the easiest to use with acceptable results (66% accuracy). As a preventive measure to eschar formation, air mattresses are more effective than foam or classical mattresses; also repositioning the patient every 4 hours is acceptable in terms of time efficiency. Depending on the score obtained using the Norton scale, other measures can be employed: keeping the skin clean and dry (as close to physiologic as possible), employing quick intervention when we observe degeneration of skin status by improving skin perfusion and maintaining good patient nutrition and hydration. After their development, evaluation of bedsores according to EPUAP (The European Pressure Ulcer Advisory Panel) is very important in deciding the subsequent treatment needed. Treatment of bedsores, regardless of their classification, requires reducing the local bacterial load by disinfection and possibly debridement of necrotic tissue; furthermore we can reduce the risk of contamination by choosing the most appropriate dressing and the frequency with which is replaced. Ulcers classified by grades 1 or 2 may be treated conservatively, while grade 3 or 4 ulcers require surgical approach. The applications of negative pressure, hyperbaric oxygen therapy, the use of cytokines or stem cells are just a few innovative alternates.

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