[Six treatment principles of the basle pressure sore concept]

The treatment of pressure sores has gained importance due to the increase of geriatric patients and general life expectancy as well as improved therapeutic options in patients with spinal cord injuries. The aetiology of pressure sores is multifactorial. Risk factors such as immobility, malnutrition, and other co-morbidities have to be considered. Therapy of pressure sores is time- and cost-consuming and recurrence rates are high. Successful treatment is based on the interdisciplinary cooperation between conservative and surgical disciplines, nursing, as well as on continuous patient education. The Basle pressure sore concept consists of six principles. Over a total treatment period of approximately three months usually two operative interventions are performed. For effective relief of pressure (1st principle) patients are placed on low-airloss beds. Operative debridement of pressure sores is performed early and systemic or local infection is treated (2nd principle). The wound is then conditioned with moist dressings or VAC (3rd principle). Simultaneously concomitant malnutrition is quantified clinically and chemically and treated by oral or, if necessary, parenteral nutrition. Other risk factors are optimised as well as possible (4th principle). Hereby optimal conditions for plastic-surgical coverage are provided (5th principle). Postoperatively a standardised concept of pressure relief and mobilisation is adhered to (6th principle). This multimodal treatment concept is well established at the University Hospital of Basle for many years. Combined with an effective prevention, the rate of pressure sores could be significantly reduced, wounds could be healed, and the number of recurrences diminished. In a two-year period between January 2004 and December 2005 the Basle plastic surgery team treated 170 pressure sores in 142 patients according to this concept in the Swiss paraplegic centre in Nottwil. In 2006, 78 % of these patients (111 patients) were followed up and recurrence rates of 23 % (26 pressure sores) were found. The Basle pressure sore concept is well established for an interdisciplinary and structured treatment of geriatric and paraplegic patients with pressure sores and provides a reliable basis for effective treatment for this complex disease.