Types of Chronic Wounds Pressure Ulcers, Testing & Treatment

Testing & Treatment

To prevent and treat pressure ulcers, special equipment should be used. It is essential to have a bed and/or wheelchair that relieves pressure. Using a low-pressure therapeutic bed may reduce the incidence of pressure ulcers by increasing blood flow to affected areas. Current models of therapeutic beds include:

1. Clinitron bed, which provides good pressure relief and is easy to get into and out of
2. Pressure-relief beds that turn the person
3. Alternating air mattresses

Currently, it is not known which type of bed is "ideal." However, two factors—pressure relief and increasing blood flow—are important when determining the best bed surface. No bed surface can prevent all pressure ulcers. The best bed is one that maximally decreases pressure and potentially increases regional blood flow.

Heel lifts or multipodus provide relief from pressure at the heel and should be worn by individuals with heel ulcers, as well as by bed-ridden individuals.

Wheelchairs should have special seat cushions in order to relieve pressure on the hips, tailbone, and buttocks.

Proper nutrition is essential for healing pressure ulcers. An endocrinologist should thoroughly evaluate and manage a person's nutritional status as soon as a pressure ulcer is detected. A holistic assessment of nutrition must include glucose, vitamin, and protein levels. Diet must be adjusted to each person's needs.

Three topical treatments have been shown to enhance wound-bed preparation:

1. Iodosorb® (cadexomer iodine) is an efficient antiseptic that does not inhibit the healing process.
2. Nanocrystaline silver-based dressings, such as Acticoat®, Actisorb Silver 220®, and Acquacel Ag®, are reported to minimize the potential of fungal infections, thereby reducing the chance of complications that delay healing.
3. Santyl® (collagenase), even though designed as a chemical debriding agent, may help stimulate blood vessels and local tissue growth.

After the topical cream is applied, the wound is packed with gauze. The gauze must go into the undermining areas of the entire wound to ensure proper healing.

Vacuum-Controlled Assisted Closure (VAC) Therapy uses negative pressure to heal wounds. VAC has a special sponge that is placed in the wound bed and covered. A vacuum, which is connected to the sponge, extracts the drainage from the wound and applies negative pressure to the site.

Debridement is a surgical procedure used to accomplish three goals:

1. Stimulate wound healing
2. Remove non-living tissue
3. Remove infected tissue

An individual who is severely anemic (has too few red blood cells in the bloodstream, resulting in insufficient oxygen to tissues and organs) may need a blood transfusion if the debridement of a pressure ulcer extends to the bone.