[Decubitus ulcers in geriatrics--pathogenesis, prevention and therapy].
Magnitude and duration of interface pressure are the crucial etiological factors in the decubitus ulcer formation. Small amounts of interface pressure that exceed the average capillary pressure (range: 2.7 to 6.3 kPa) may lead to compression of the skin microcirculation and resultant tissue necrosis when a critical duration of interface pressure of more than 2 h is reached. The principles of decubitus ulcer prevention are derived from the pathophysiology of ulcer formation as noted: reduction of interface pressure below 3 kPa by bedding each at-risk patient on a 'super-soft' mattress and shortening the duration of interface pressure below 2 h. by turning of patients from the supine position to the right and left 30 degrees oblique back position every two hours. Decubitus ulcers typically show impaired wound healing. Conditions most conspicuously protracting normal wound healing are: tissue hypoxia, fibrin deposits, necrotic tissue, local infection, defective migration of keratinocytes, impaired general condition, etc. Based on these pathophysiological mechanisms, five therapeutical principles are proposed: complete relief of interface pressure, débridement of necrotic tissue, treatment of infection using systemical antibiotics, wet and air-permeable wound dressing, improvement of patient's general condition.
Seiler
W O
WO
Medizinisch-Geriatrische Klinik, Kantonsspital Basel.
Stähelin
H B
HB
D000368:Aged; D001513:Beds; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000628:therapy; D008833:Microcirculation / Q000503:physiopathology; D003668:Pressure Ulcer / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D012867:Skin / Q000098:blood supply*
Dekubitalulzera in der Geriatrie--Pathogenese, Prophylaxe und Therapie.