The decubitus ulcer: facts and controversies.
Defining the decubitus ulcer proves as difficult as agreeing on a name for the condition. Causes include pressure over bony prominences, shearing force, destruction of skin, and compromised blood flow. Evidence is emerging of the importance of ischemia as a primary causative agent, rather than pressure, which needs further investigation. Scales, staging, and treatment and prevention guidelines should be used with caution due to their arbitrary implementation and lack of evidence-based support. Unfortunately, much of the research and expert opinion developed by the government and touted as regulation lacks appropriate strength-of-evidence. Although decubitus ulcers should be prevented and treated to the best of our abilities, recognizing the possibility that the skin, like any other organ in the body, may fail is crucial.
Campbell
Caren
C
Department of Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19103, USA. caren.campbell@jefferson.edu
Parish
Lawrence Charles
LC
D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications*; D008297:Male; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000145:classification / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications