Management of pressure ulcers.

Pressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure ulcers is the loss of the ability of bedridden patients to move spontaneously. When this ability is impaired by neurologic injury or debility, damage caused by unrelieved pressure against tissue trapped between the support surface and a bony prominence becomes evident. Current recommendations for prevention advise providing optimal skin care to those at risk of tissue breakdown. Once a pressure ulcer is diagnosed, an initial assessment, including staging the ulcer and a comprehensive assessment, is required. A treatment plan can then be devised. Planning should include management of tissue loads, ulcer care, and nutritional support. The dogma that all pressure ulcers are caused by poor care should be recognized as incorrect. Even the most exemplary care may not prevent the development of, or heal existing, pressure ulcers in high-risk patients.