Practice ABC of wound healing

Pressure ulcers

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7539.472 (Published 23 February 2006) Cite this as: BMJ 2006;332:472
  1. Joseph E Grey,
  2. Keith G Harding,
  3. Stuart Enoch, research fellow
  1. Royal College of Surgeons of England and is based at the Wound Healing Research Unit, Cardiff University.

    A pressure ulcer is defined by the European Pressure Ulcer Advisory Panel as an area of localised damage to the skin and underlying tissue caused by pressure, shear, or friction, or a combination of these. Pressure ulcers are caused by a local breakdown of soft tissue as a result of compression between a bony prominence and an external surface.

    They usually develop on the lower half of the body: two thirds around the pelvis and a third on the lower limbs, with heel ulceration becoming more common. Elderly people are the most likely group to have pressure ulcers; this is especially true for those older than 70, up to a third of whom will have had surgery for a hip fracture. Those with spinal injuries form another distinct group, in whom the prevalence is 20%-30% one to five years after injury.



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    Common sites of pressure ulceration in individuals at risk of ulceration

    Most pressure ulcers arise in hospital, where the prevalence among inpatients is 3%-14%, although it can be as high as 70% in elderly inpatients with orthopaedic problems. The incidence of pressure ulcers in hospitals is 1%-5%. In patients who are confined to bed or to a chair for more than one week, the incidence rises to almost 8%. In long term healthcare facilities 1.5%-25% of patients develop pressure ulcers. Almost a fifth of pressure ulcers develop at home and a further fifth in nursing homes. The prevalence of pressure ulcers in nursing homes is not much higher than in hospitals. Pressure ulceration in elderly patients is associated with a fivefold increase in mortality, and in-hospital mortality in this group is 25%-33%. Estimates of the cost of pressure ulceration to the NHS range from £180m ($318m; €265m) to nearly £2bn a year.

    Pathogenesis

    The four main factors implicated are interface …

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