title: An evidence-based approach to the surgical management of pressure ulcers.
abstract: OBJECTIVE
  This study aims to use the evidenced-based approach to better understand the surgical management and treatment of pressure ulcers.
  
  
  BACKGROUND
  Pressure sores are a cause of significant morbidity in the medical community. Although there are a multitude of preventative and treatment options, there remains some degree of uncertainty in the literature in defining the best way to treat and manage pressure sores.
  
  
  METHODS
  An exhaustive literature search was performed using several electronic databases. The search revealed several identified modalities for treatment of pressure ulcers. We then assessed each modality individually for the level of evidence that exists in the most current literature, with preference given to more recent studies (2005-present).
  
  
  RESULTS
  Here, we reviewed the most relevant, high-level evidence that exists for the following modalities for managing pressure ulcers from a surgical perspective: wound cleansers, repositioning, negative pressure therapy, enteral and parenteral feeding, vitamin and mineral supplementation, specialized mattresses, ultrasound therapy, honey, cellular therapy, debridement, ostectomy, and musculocutaneous and fasciocutaneous flap closure.
  
  
  CONCLUSIONS
  Although many of the previously mentioned modalities are used, we encourage clinicians and health care providers to consider the evidence-based data when deciding how to most appropriately manage their patient's pressure sores.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA. steven.levine@nyumc.org
authors.forename: Steven M
authors.initials: SM
authors.lastname: Levine
authors.forename: Sammy
authors.initials: S
authors.lastname: Sinno
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.forename: Pierre B
authors.initials: PB
authors.lastname: Saadeh
mesh_terms: D003646:Debridement; D019317:Evidence-Based Medicine; D006801:Humans; D010027:Osteotomy; D011300:Preoperative Care / Q000379:methods; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000637:transplantation; D058106:Wound Closure Techniques