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Decubitus UlcerAka: Decubiti, Pressure Ulcer, Pressure Sore

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  1. 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
  2. Labs
    1. Wound culture not indicated
  3. Differential Diagnosis
    1. See Leg Ulcer Causes
    2. Stasis ulcer
      1. Venous Insufficiency
      2. Lymphedema
    3. Ischemic ulcer (Peripheral Vascular Disease)
    4. Vasculitic ulcer
  4. 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
  5. Management: Nutrition
    1. See Nutrition in Wound Healing
  6. 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)
  7. 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
  8. Course
    1. Anticipate some healing in 2 to 4 weeks
  9. Complications
    1. Cellulitis (bacterial superinfection) or Sepsis
      1. Stage 2-5 pressure ulcers colonized with bacteria
      2. Adequate cleansing and debridement prevents infection
    2. Osteomyelitis
      1. Suspect if non-healing ulcer after 2 to 4 weeks
  10. References
    1. Bello (2000) JAMA 283(6):716
    2. Degreef (1998) Dermatol Clin 16(2):365
    3. Findlay (1996) Am Fam Physician 54(5):1519
    4. Habif (1996) Clinical Derm, Mosby, p. 810-13
    5. Knapp (1999) Pediatr Clin North Am 46(6):1201
    6. Krasner (1995) Prevention Management Pressure Ulcers
    7. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
    8. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
    9. PUGP (1995) Am Fam Physician 51(5):1207
    10. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
    11. Way (1991) Current Surgical, Lange, p.95-108

Decubitus ulcer (C0011127)

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 (NCI)Death of tissue due to external pressure.
Definition (NCI)Death of tissue due to external 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.
ConceptsDisease or Syndrome (T047)
ICD9707.0, 707.0, 707.00
MSHD003668
EnglishBed sore, Bed Sores, Bedsore, Bedsores, Contact ulcer, Decubitus, Decubitus pressure sore, DECUBITUS SKIN ULCER, Decubitus ulcer, Decubitus ulcer any site, Decubitus Ulcers, Pressure Sore, Pressure Sore Or Ulcer, pressure sores, Pressure Sores/Ulcers, Pressure Ulcer, Pressure Ulcers
Spanishdecubito, escara, ulcera de contacto, ulcera de decubito, ulcera de presion, ulcera por decubito, ulcera por presion
Parent ConceptsChronic skin ulcer (C0157738), Skin Ulcer (C0037299), Decubitus ulcer (C0011127), Ulcer (C0041582), Chronic ulcer (C0333297), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesCCS, COSTAR, CSP, DXP, ICD9CM, LNC, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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