Management of Pressure Ulcers and Pressure-Related Injury

Purpose of Review Pressure ulcers, or pressure-related injuries, result from localized injury to the skin and underlying tissues due to unrelieved pressure, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis. Pressure injuries are increasing in incidence due to an aging population with increasing rates of obesity, diabetes, and cardiovascular disease. A rapidly expanding geriatric population with impaired mobility, diminished sensation, and poor nutrition—factors exacerbated by the end-stage effects of dementia, obesity, osteoarthritis, and diabetes as well as cardiovascular and cerebrovascular disease—have a greater propensity toward, and a higher prevalence of, pressure injury. Our aim in this paper is to determine through a review of the literature whether any new literature exists, indicating greater effectiveness in pressure ulcer prevention or treatment as compared to standard of care. We examined which studies of available support surfaces, new and currently utilized wound dressings or any other treatment modalities have provided evidence of any greater effectiveness than standard of care in the prevention of pressure injury and in promotion of pressure ulcer healing. Our objective is to provide healthcare providers with an assessment of the relative efficacy of the various interventions available to facilitate their decision-making in the healing of their patient’s pressure ulcers. Goals for pressure injury prevention or treatment, especially in the geriatric population, address repositioning for pressure redistribution and accurate diagnosis of wound etiology, including comorbidities in aging, cognition, care of aging skin, and patient or family goals in care (healing versus palliation).