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Definition:
Pressure ulcer, also known as
decubitus ulcer, is a breakdown and ulceration
of tissue overlying a bony prominence due to a
ischemic neurosis from prolonged pressure
against an external object. Often a secondary
infection is also present. |
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Etilogy:
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Extrinsic
Factors: The most important factor is
pressure on soft tissue often over a bony
prominence due to infrequent shifting of
weight. Friction, shear force and skin
irritation add to the degree of necrosis.
Excess moisture leads to further tissue
maceration. Decreased activity and morbidity
are further factors.
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Intrinsic Factors:
Loss of the sensation of pain and pressure is a
common factor. Often there is inadequate fat
and muscle padding due to disuse atrophy and/or
malnutrition. Inadequate nutrition, involuntary
weight loss, increasing age and smoking are also
factors.
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Characteristics:
The pressure ulcer can be perceived as a pyramid
of tissue injury with much more damage at the
base of the wound then is evident on the
surface. There it is easy to underestimate the
injury using appearance alone. Understanding
the pathophysiology is key to proper diagnosis.
The severity of the ulceration is best described
using the National Pressure Ulcer Advisary Panel
system shown below.
Pressure Ulcer Classififcation
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Stage 1:
reddened areas on the skin which when
pressed is non-blanchable (does not turn
white) indicating the development of
damaged skin
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Stage 2:
partial thicknes skin loss, forming an
open sore, involving the epidermis and
part of the dermis
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Stage 3:
full thickness skin loss also involving
damage to the subcutaneous tissue
producing a crater
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Stage 4:
full thickness skin loss with extensive
necrosis of underlying fat, muscle and
bone
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This staging
system describes a dynamic process of
progressive tissue necrosis such that if
not immediately treated, a stage 1 ulcer
will continue to progress to stage 2 and
so forth. Undermining is common in stage 3
and stage 4 ulcers. Tunnels are present which
need to be managed by the local wound
care. |
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