Pressure ulcer treatment

Product Quick Finder

Choose a category or subcategory

Did you know that

„Pressure ulcers can occur quickly - between the first hour and 4 to 6 hours after sustained loading.“

– A. Gefen (1)

„One to four of every ten hospitalized patients develop pressure ulcers.“

– Range varies among settings and classification method. (2)

„In areas affected by COVID-19 lockdown only 22,6% of patients with chronic wounds went to the wound clinics as usual, and 1 in 10 did not change the wound dressing at all during that whole period.“

– Tinelli, G. et al. (3)

It's time to act

Most of the time, pressure sores significantly impact the patients’ morbidity, mortality and quality of life. Once a pressure ulcer has developed, it is important to draw up a coordinated treatment plan to promote healing. The basic prerequisites for wound healing must be met and everything that interrupts this process needs to be avoided. These include pressure ease, a clean wound, functioning circulation, and adequate nutrition in terms of both calories and nutrients along with adequate fluid intake.

Care of stage 1 pressure sores

Depending on the extent of tissue damage, pressure sores are categorized into four stages(4). Every stage requires a specific treatment.

Stage 1 pressure ulcers

Description

Non-blanchable erythema of intact skin; superficial

Goal

  • Skin repair
  • Restore capillary function
  • Protect against friction

How to care for stage 1 pressure ulcers

Hydrate the skin

Linovera®  is a solution of hyperoxygenated fatty acids (HOFA)(5,6) indicated for prevention and treatment of stage 1 pressure ulcers. It promotes blood microcirculation reducing the risk of ischemia and facilitating the renewal of epidermal cells. It protects against friction,(7) reduces skin fragility and prevents dehydration of the skin.(8,9)

Protect from friction

Askina® Heel(10) is a non adhesive hydrocellular heel dressing that protects the heel area from shear stresses and reduces pressure from external forces.

Askina® DresSil Border Lite(10) is a thin, soft, discreet and conformable foam dressing for different anatomical contours. It is indicated for use on non to low exuding wounds.

Treatment of stage 2 pressure sores

Stage 2 pressure ulcers

Description

Partial-thickness skin loss with exposed dermis; superficial

Treatment goals

  • Remove blisters
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Manage local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix providing a broad spectrum antimicrobial effectiveness on infected wounds and preventing contamination from external bacteria.

Manage wound odor

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Manage wound exudate

Askina® DresSil Sacrum(13), Askina® DresSil Heel(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Protect the periwound skin

Askina® Barrier Cream(13) acts as a protectant and moisture barrier against maceration caused by incontinence or body fluids, to protect sensitive, fragile skin and severely dry skin, including periwound areas. It is indicated for use on intact skin.

Askina® Barrier Film Swab(13) and Askina® Barrier Film Spray(13) are sterile liquid dressings which form a transparent film when applied to the skin. The film possesses good oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Treatment of stage 3 pressure sores

Stage 3 pressure ulcers

Description

Full-thickness skin loss; deep

Treatment goals

  • Debride
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Manage local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix providing a broad spectrum antimicrobial effectiveness on infected wounds and preventing contamination from external bacteria.

Manage wound odor

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Manage wound exudate

Askina® DresSil Sacrum(13), Askina® DresSil Heel(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam, a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Add a cavity absorbent dressing 

Askina® Sorb Rope(13) is a highly absorbing alginate dressing. It is ideally suited for the management of moderate to heavily exuding cavity wounds.

Protect the periwound skin

Askina® Barrier Cream(13) acts as a protectant and moisture barrier against maceration caused by incontinence or body fluids, to protect sensitive, fragile skin and severely dry skin, including periwound areas. It is indicated for use on intact skin.

Askina® Barrier Film Swab(13) and Askina® Barrier Film Spray(13) are sterile liquid dressings which form a transparent film when applied to the skin. The film possesses good oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Treatment of stage 4 pressure ulcers

Stage 4 pressure ulcers

Description

Full-thickness skin and tissue loss; deep

Treatment goals

  • Debride
  • Protect organs
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Manage biofilm

Prontosan® Wound Irrigation Solution(10) is indicated for cleansing irrigation and moistening of acute and chronic wounds.

  • Prevents infection(11)
  • Helps to prevent biofilm formation
  • Reduces healing time(12)

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.

Prontosan® Gel X(10) proper wound cleansing is essential. The use of Prontosan® Wound Gel X provides long-lasting cleansing and decontamination of the wound bed between dressing changes.

Prontosan® Debridement Pad(10) has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Manage local infection

Askina® Calgitrol® is a range of dressings with an ionic silver alginate matrix providing a broad spectrum antimicrobial effectiveness on infected wounds and preventing contamination from external bacteria.

Manage wound odor

Askina® Carbosorb(13) is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Manage wound exudate

Askina® DresSil Sacrum(13), Askina® DresSil Heel(13), Askina DresSil(13), Askina® DresSil Border(13) help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, a highly absorbent polyurethane foam, a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Foam(13) and Askina® Heel(9) help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with high absorption capacity and a vapour permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Add a cavity absorbent dressing 

Askina® Sorb Rope(13) is a highly absorbing alginate dressing. It is ideally suited for the management of moderate to heavily exuding cavity wounds.

Protect the periwound skin

Askina® Barrier Cream(13) acts as a protectant and moisture barrier against maceration caused by incontinence or body fluids, to protect sensitive, fragile skin and severely dry skin, including periwound areas. It is indicated for use on intact skin.

Askina® Barrier Film Swab(13) and Askina® Barrier Film Spray(13) are sterile liquid dressings which form a transparent film when applied to the skin. The film possesses good oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

References:

1) Gefen, A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/18927481"Ostomy Wound Manage. 2008 Oct;54(10):26-8, 30-5.

2) Range varies among settings and classification method. 

  • Bereded DT, Salih MH, Abebe AE. Prevalence and risk factors of pressure ulcer in hospitalized adult patients; a single center study from Ethiopia. BMC Res Notes. 2018;11(1):847. Published 2018 Nov 29. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC626787
  • Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007;13(2):227-35. (https://www.ncbi.nlm.nih.gov/pubmed/17378869)
  • Barrois B, Labalette C, Rousseau P, et al. A national prevalence study of pressure ulcers in French hospital inpatients. J Wound Care. 2008;17(9):373-6, 378-9. (https://www.ncbi.nlm.nih.gov/pubmed/18833894)
  • Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care. 2008;13(2):71-9 (https://www.ncbi.nlm.nih.gov/pubmed/18289185)
  • Vangilder C, Lachenbruch C, Algrim-boyle C, Meyer S. The International Pressure Ulcer Prevalence™ Survey: 2006-2015: A 10-Year Pressure Injury Prevalence and Demographic Trend Analysis by Care Setting. J Wound Ostomy Continence Nurs. 2017;44(1):20-28.(https://www.ncbi.nlm.nih.gov/pubmed/27977509)

3) Tinelli G, Sica S, Guarnera G, Pitocco D, Tshomba Y. Wound Care during COVID-19 Pandemic [published online ahead of print, 2020 Jun 24]. Ann Vasc Surg. 2020;S0890-5096(20)30545-8. doi:10.1016/j.avsg.2020.06.044; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311334

4) Haesler E (Ed.) EPUAP/NPIAP/PPPIA, (2019), Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance

5) López-Pérez R, Gutiérrez Ibáñez B, Incidence of pressure ulcers (bed sores) in patients on treatment with hyperoxygenated fatty acids. (Asturias, Spain). Unpublished.

6) Instructions for use Linovera®

7) Jimenez Torres J. (2010), Acidos Grasos Hiperoxigenados (AGHO) en el tratamiento y prevencion de las ulceras por presion, ulceras vasculares y pie diabetico. Panorama actual del medicamento 2010; 34(336):695-701

8) Declair V, (1997), The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers. Ostomy Wound Manage 43(5):48-52, 54.

9) Colin D, Chomard D, Bois C, Saumet JL, Desvaux B, Marie M, (1998), An evaluation of hyper-oxygenated fatty acid esters in pressure sore management. J Wound Care 7(2):71-2.

10) Cf. Instruction for use: Askina® Heel, Askina® DresSil Border Lite, Prontosan® Wound Irrigation Solution, Prontosan® Gel X, Prontosan® Debridement Pad

11) Moore M, (2016), 0.1% Polyhexanide-Betaine Solution as an Adjuvant in a Case-Series of Chronic Wounds. Surg Technology International.

12) Bellingeri A, Falciani F, Traspedini P, et al, (2016), Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. J Wound Care. 25(3):160-168. doi:10.12968/jowc.2016.25.3.160.

13) Cf. Instruction for use: Askina® Calgitrol® Paste, Askina® Calgitrol® Thin, Askina® Calgitrol® Ag, Askina® Carbosorb, Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border, Askina® Foam, Askina® Sorb Rope, Askina® Barrier Cream, Askina® Barrier Film Spray, Askina® Barrier Film Swabs.

14) Downie F, Sandoz H, Gilroy P, Royall D, Davies S, (2013). Are 95% of hospital-acquired pressure ulcers avoidable?. Wounds UK. 9. 16-22.3