[Prevention and treatment of pressure ulcers]

Pressure is the primary pathogenic factor in the development of ulcers but other major factors are shearing forces, friction and moisture. Significant risk factors are immobility, nutritional status and age-related diseases. Complications of pressure ulcers can be life threatening. The authors wish to stress preventive measures and also recommend a therapeutic approach based on the grade of ulcer present. Prevention is best achieved by identification of high risk patients, alleviation of causative and predisposing factors and early detection of ischemic skin changes. The treatment includes local wound care that eliminates necrotic tissue, decreases bacterial load and provides a physiologic environment allowing the wound to heal, and systemic treatment: adequate nutrition, correction of underlying illnesses and systemic antibiotics (in case of sepsis, cellulitis, osteomyelitis or the prevention of bacterial endocarditis).