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Decubitus Ulcer

Aka: Decubitus Ulcer, Decubiti, Pressure Ulcer, Pressure Sore
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  1. Epidemiology
    1. Incidence: 17-35% in Nursing Home residents
  2. Signs: Distribution
    1. Heel
    2. Sacrum
    3. Ischial tuberosity
    4. Buttock
  3. Examination: Ulcer Characterization
    1. See Ulcer Grading (Types I to IV)
    2. Location
    3. Stage
    4. Size (Length x Width x Depth)
    5. Sinus tracts
    6. Exudate
    7. Necrotic tissue
    8. Granulation tissue
    9. Discharge and signs of infection
  4. Labs
    1. Wound culture not indicated
  5. Differential Diagnosis
    1. See Leg Ulcer Causes
    2. Stasis ulcer
      1. Venous Insufficiency
      2. Lymphedema
    3. Ischemic ulcer (Peripheral Vascular Disease)
    4. Vasculitic ulcer
  6. Management: General Approach
    1. Weekly clinical assessment
    2. Daily observation by caregiver
    3. Key point: Minimize moisture, friction and sheering
      1. Without this, no Pressure Sore will heal
      2. Consider clinitron bed (expensive: $100/day)
    4. See Pressure Sore Positioning
    5. See Decubitus Ulcer Debridement
    6. See Decubitus Ulcer Cleansing
    7. See Wound Dressing
  7. Management: Nutrition
    1. See Nutrition in Wound Healing
  8. Management: Control source of pain
    1. Cover wounds
    2. Adjust support surfaces
    3. Reposition patient frequently
    4. Provide analgesia with dressing changes and debridement
    5. Control moisture
      1. Contributes to maceration and skin breakdown
      2. Airflow surface may help keep area dry
      3. Do not use Incontinence briefs (impedes airflow)
  9. Management: Adjunctive Therapy
    1. Electrotherapy (Electrical stimulation)
      1. Grade 3-4 Pressure Ulcers refractory to other care
    2. Insufficient evidence to support use of other adjuncts
      1. Topical and systemic agents
      2. Hyperbaric treatment
      3. Infared or ultraviolet light exposure
  10. Course
    1. Anticipate some healing in 2 to 4 weeks
  11. Complications
    1. Osteomyelitis
      1. Suspect if non-healing ulcer after 2 to 4 weeks
    2. Cellulitis (bacterial superinfection) or Sepsis
      1. Stage 2-5 Pressure Ulcers colonized with bacteria
      2. Adequate cleansing and debridement prevents infection
      3. Size and depth of ulcer does not distinguish need for antibiotics
      4. Findings suggestive of infection
        1. Fever
        2. Leukocytosis
        3. Increased purulent discharge
        4. Necrotic tissue
        5. Surrounding erythema
  12. References
    1. Habif (1996) Clinical Derm, Mosby, p. 810-13
    2. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
    3. PUGP (1995) Am Fam Physician 51(5):1207-22
    4. Krasner (1995) Prevention Management Pressure Ulcers
    5. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
    6. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
    7. Way (1991) Current Surgical, Lange, p.95-108
    8. Bello (2000) JAMA 283(6): 716-8
    9. Degreef (1998) Dermatol Clin 16(2): 365-75
    10. Findlay (1996) Am Fam Physician 54(5): 1519-28
    11. Knapp (1999) Pediatr Clin North Am 46(6):1201-13
    12. Stotts (1997) Clin Geriatr Med 13(3): 565-73

Pressure Ulcer (C0011127)

Definition (NCI) Death of tissue due to external pressure.
Definition (MEDLINEPLUS)

Pressure sores are areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips. You are at risk if you are bedridden, use a wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which are life-threatening. They can be a problem for people in nursing homes.

You can prevent the sores by

  • Keeping skin clean and dry
  • Changing position every two hours
  • Using pillows and products that relieve pressure

Pressure sores have a variety of treatments. Advanced sores are slow to heal, so early treatment is best.
Definition (CSP) ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time; bony prominences of the body are the most frequently affected sites; ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure.
Definition (MSH) An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stay in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.
Definition (NCI) Death of tissue due to external pressure.
Concepts Disease or Syndrome (T047)
MSH D003668
ICD9 707.0, 707.00
ICD10 L89
SnomedCT 156424003, 165258002, 142668003, 400192002, 399912005, 28103007, 201248003, 418172001, 90144002, 420226006
English Decubitus, pressure sores, Bed Sores, Bedsore, Pressure Sore, Pressure Ulcers, Sore, Bed, Sores, Bed, Sores, Pressure, Ulcers, Decubitus, Ulcers, Pressure, Decubiti, DECUBITUS SKIN ULCER, BEDSORE, Bed Sore, Decubitus ulcer (specify), Sore, Pressure, Ulcer, Decubitus, Ulcer, Pressure, Pressure sore(s), Pressure Sore Or Ulcer, Skin Decubitus Ulcer(s), chronic decubitus ulcer (diagnosis), chronic decubitus ulcer, bed sores, decubitus ulcer, Decubitus ulcers, Pressure Sores, Bedsores, Decubitus Ulcers, Bed sores, DECUBITUS ULCER CHRONIC, DECUBITUS ULCER, Pressure Ulcer, Pressure ulcer, site NOS, PRESSURE, NECROSIS, ULCERS/SORES, PRESSURE, NECROSIS, PRESSURE, SORES/ULCERS, PRESSURE, PRESSURE SORES/ULCERS, bed sore, Pressure Ulcer [Disease/Finding], Pressure ulcers, contact ulcers, Ulcer;decubitus, Pressure;sore, pressure ulcers, contact ulcer, decubitus skin ulcers, decubitus ulcers, Bed sore, Contact ulcer, Decubitus ulcer, Pressure sore, Decubitus pressure sore, Decubitus ulcer (disorder), Pressure sore (disorder), decubitus, bedsore, decubitus; ulcer, pressure sore; sore, pressure ulcer; ulcer, pressure; sore, pressure; ulcer, skin; ulcer, decubitus, sore; pressure sore, sore; pressure, ulcer; decubitus, ulcer; pressure ulcer, ulcer; pressure, ulcer; skin, decubitus, Decubitus (pressure) ulcer, pressure ulcer, Decubitus ulcer, unspecified site, Decubitus Ulcer, pressure sore, Pressure ulcer, Decubitus ulcer (finding), Decubitus ulcer (morphologic abnormality), Pressure ulcer (morphologic abnormality)
Spanish úlcera de decúbito (anomalía morfológica), úlcera de decúbito, úlcera por presión (anomalía morfológica), Ulcera por presión durante el decúbito, úlcera por decúbito (hallazgo), úlcera por decúbito (específica), Decubitus (pressure) ulcer, Decubitus ulcer, Pressure sore, Bed sore, decúbito, escara, úlcera de contacto, úlcera de presión, úlcera por decúbito (trastorno), úlcera por decúbito, úlcera por presión (trastorno), úlcera por presión, Úlcera de decúbito, Escara, Llaga por Presión, Úlcera por Decúbito, Úlcera por Presión, Llaga por Presion, Ulcera por Decubito, Ulcera por Presion
Italian Ulcerazione da decubito, Piaga da letto, Ulcera da pressione, Decubitus ulcer, Piaghe da letto, Ulcera da decubito, Piaga da decubito
Dutch drukzweer, doorliggen, decubitus; ulcus, druk; ulcus, druk; zweer, drukulcus; ulcus, drukzweer; zweer, huid; ulcus, decubitus, ulcus; decubitus, ulcus; drukulcus, ulcus; druk, ulcus; huid, decubitus, zweer; drukzweer, zweer; druk, decubitus ulcus, Decubitus, Decubitusulcus, Doorliggen, Drukulcus
German Druckgeschwuer, Dekubitalgeschwuer, Dekubitus, Druckulkus, Wundliegen, Dekubitalgeschwür, Druckgeschwür
Portuguese Ferida de decúbito, Ferida de pressão, Úlcera por Pressão, Úlcera de Pressão, Úlceras de decúbito, Escara de Decúbito, Úlcera de Decúbito
Swedish Trycksår
Japanese ｼﾞｮｸｿｳｾｲｶｲﾖｳ, ｼﾞｮｸｿｳ, 褥瘡性潰瘍, 圧迫性潰瘍, じょく瘡性潰瘍, とこずれ潰瘍, 圧迫痛(褥創), 褥瘡, とこずれ, 床ずれ, 褥創, 褥創潰瘍, 褥瘡潰瘍
Czech otlakový vřed, dekubitus, proleženina, Proleženina, Proleženina z tlaku na podložku, Dekubitální vřed
Finnish Painehaava
Russian PROLEZHEN', ПРОЛЕЖЕНЬ
Korean 욕창성 및 압박부위 궤양
Croatian DEKUBITUS
Polish Odleżyna
Hungarian Felfekvéses fekély, Felfekvés, Decubitus fekély
French Escarre, Ulcère de décubitus, Escarre de décubitus, Escarre de pression, Ulcère de pression
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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