Pressure ulcers: a review

Pressure ulcers are a localized area of tissue necrosis that develop when soft tissue is compressed between a bony prominence and an external surface. This condition has been recognised for at least 5000 years and its incidence has been on the rise due to an increasing geriatric population. All the while the cost of managing pressure ulcers has also been on the rise, overburdening health care delivery systems worldwide, especially more so in developing nations. Currently pressure ulcers are seen as a preventable entity, therefore prevention should be a priority in their management. The management of established pressure ulcers has progressed over the past 50 years and todays practice consists of serial wound dressings with debridement if required. More orthodox reconstructive surgical procedures are reserved for grade 3 and 4 ulcers. There has been a drastic reduction in the associated mortality and morbidity associated with pressure ulcers, but literature still reports complications in long standing cases such as acute sepsis, heterotopic ossification, joint sepsis, malignant transformation and the development of osteomyelitis of the underlying bone. This review article aims to outline the mechanism of development, presentation, aetiology, diagnosis, prevention and management, both non-surgical as well as surgical and newer advances in treatment of pressure ulcers.