Pressure sores need close attention as soon as they are noticed. This post discusses the management of Stage I and II pressure sores. At these stages, the skin is not broken open or the wound is very shallow. With good care, these wounds should look much better within a week. Follow-up with a healthcare provider is needed if there is no improvement. This is especially true for patients with diabetes or any advanced illness. 

Step 1: Relieve pressure and remove moisture. 

Remove all pressure from a wound for as many hours as possible. In addition, avoid prolonged periods in one position. A simple example is a Stage II sore on the buttocks. It takes extra effort to reposition frequently throughout the day and night. But this is important. It is better than having a person on the side all day and on the back all night. A wet environment can also worsen the wound, especially if the person is incontinent. Keep the area dry. 

Step 2: Emphasize a high calorie and high protein diet. 

Sores will not heal if a person is malnourished. Even if a person is overweight, weight loss can be problematic. In fact, caloric intake needs are at least fifty percent higher among seniors who have a pressure sore. Foods with a higher fat content will provide more calories. Nutritional supplements are helpful if they are given in addition to regular food, not in replacement of regular food. Protein is especially important for tissue healing. Zinc and Vitamins A and C are helpful for wound healing and are available as supplements. 

Step 3: Care of the wound

• Keep the wound clean to prevent infection. 

Gently clean the sore with mild soap and water every time you change a dressing. Do not use hydrogen peroxide or iodine since they can damage skin. Use a clean washclothor strong paper towel. Do not scrub. Whisk away any foreign particles. Then drape and pat the entire area dry.

• Sometimes open skin will bleed. 

Bleeding is actually a good sign because it means circulation is good. But bleeding should be stopped before applying a dressing. This was discussed in a previous post. 

• Should I leave a wound open to air?

As a rule of thumb, the answer is no. A stage I wound has intact skin. It may heal if there is absolutely no pressure on the wound. But even for these sores, a cream or dressing is an added layer of cushioning and protection. Stage II open sores heal better in a moist protected environment. 

• Use a barrier cream when there is a large area involved.

• Use a “hydrocolloid” dressing when sores are 3 inches and smaller.

Do not use regular bandages or gauze. Bandages can damage delicate skin. Gauze can stick to wounds. Instead, use hydrocolloid dressings. They are especially designed for pressure sores. 

Hydrocolloid dressings are self-adherent wafer-like protective sheets. They provide a clean, moist, and healing environment while also absorbing drainage. They provide cushioning and tissue protection. These dressings are meant for most Stage I or II ulcers. However, they are not meant for heavily draining or infected wounds. Creams should not be applied underneath this dressing. 

Hydrocolloid dressings come in assorted sizes, shapes, and thicknesses. Use the one that is best for the wound. Thin dressings are more flexible. Thicker dressings absorb more drainage and provide more cushion. Make sure that the dressing covers the whole wound with an inch of margin around the sides. These dressings can be cut with scissors. Round off the corners to avoid peeling there. Warm the dressing with your hands to make it softer. Expose the sticky surface. Then, use the entire hand to apply the dressing evenly over the wound.

Hydrocolloid dressings can be left in place for as long as a week. They are water resistant and do not come off in the shower. One disadvantage of these dressings is that they are not clear. The wound cannot be seen through the dressing. However, the dressing does not need to be removed if it stays dry. If it becomes wet or boggy, it needs to be replaced. At that time, make sure the wound looks improved. If it doesn’t, contact a healthcare provider. 

Step 4: When should I contact a healthcare professional?

Stage III/IV and unstageable wounds require expert evaluation and management. This is also true for any wound that doesn’t steadily improve. Some patients have a history of wounds, are at risk for multiple wounds, or have advanced illness. A healthcare provider should see these patients.

There are many different advanced dressings including “alginates” , “hydrogels” and “polymerics”. These have specific indications and are more expensive. Severe wounds are sometimes managed using a suction vacuum dressing. Specialized wound care beds are prescribed when needed. The cost of these beds is often covered by medical insurance.

Major wounds need close attention. A treatment may work for one wound but not for another. Most cities have wound care specialists. Make sure that the healthcare provider is dependable and examines the wound regularly. If a wound does not improve, treatment should be modified. In some cases, wounds do not heal because of end-of-life issues. 

Warmest Aloha,

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PS: I say it over and over again: There’s no one more important than the caregiver in the daily life of a frail person.