Decubitus ulcers
Background
- Classified into stages based on thickness
- External compression of skin causes ischemic tissue damage, necrosis which is common in
- Bedridden patients
- Nursing home patients
Clinical Features
- Stage 1 - Epidermal redness only
- Stage 2 - Erosion into epidermis only (dermis is intact)
- Stage 3 - Deep necrosis/ulceration to all skin layers above fascia
- Stage 4 - Full thickness ulceration revealing muscle and bone
Differential Diagnosis
Evaluation
- The most important piece of the evaluation is early identification and classification especially for patients being admitted.
- For deep wounds and in patients with signs of sepsis, evaluate for hematogenous spread (blood cultures) or osteomyelitis (imaging or deep culture)
Management
- Stage 1 and 2 ulcers
- Wound care and dressing changes in addition to padding to relief pressure
- Stage 2 and 3 ulcers
- Surgical debridement and ongoing intensive wound care and pressure relief
Disposition
- Disposition is not dependent on the degree of ulcer but rather depends on the patient's clincal condition
See Also
External Links
References
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