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Evidence-Based Medicine: Pressure Sores

Cushing, Carolyn A. M.D.; Phillips, Linda G. M.D.

Plastic and Reconstructive Surgery: December 2013 - Volume 132 - Issue 6 - p 1720–1732
doi: 10.1097/PRS.0b013e3182a808ba
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Learning Objectives: After studying this article, the participant should be able to: 1. Cite risk factors for pressure sore development. 2. Detail the pathophysiology of pressure sores. 3. List the types and classification of pressure sores. 4. Consider the various nonsurgical conservative wound management strategies. 5. Describe the appropriate surgical interventions for each pressure sore type. 6. Understand the causes of recurrent pressure sores and methods of avoiding recurrence.

Summary: Pressure sores are the result of unrelieved pressure, usually over a bony prominence. With an estimated 2.5 million pressure ulcers treated annually in the United States at a cost of $11 billion, pressure sores represent a costly and labor-intensive challenge to the health care system. A comprehensive team approach can address both prevention and treatment of these recalcitrant wounds. Consideration must be given to the patient’s medical and socioeconomic condition, as these factors are significantly related to outcomes. Mechanical prophylaxis, nutritional optimization, treatment of underlying infection, and spasm control are essential in management. A variety of pressure sore patterns exist, with surgical approaches directed to maximize future coverage options. A comprehensive approach is detailed in this article to provide the reader with the range of treatment options available.

Supplemental Digital Content is available in the text.

Galveston, Texas

From the Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch.

Received for publication February 28, 2012; accepted June 12, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Linda G. Phillips, M.D., 301 University Boulevard, Galveston, Texas 77555-0724,

©2013American Society of Plastic Surgeons