Moving and regularly changing your position helps to relieve the pressure on ulcers that have already developed. It also helps prevent pressure ulcers developing.
After your care team has carried out an assessment of your risk of developing pressure ulcers, they will draw up a repositioning timetable. This states how often you need to move, or be moved if you're unable to do so yourself.
For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two to four hours.
You may also be given training and advice about:
- correct sitting and lying positions
- how you can adjust your sitting and lying positions
- how best to support your feet to relieve pressure on your heels
- any special equipment you need and how to use it
Mattresses and cushions
If you're at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend a specially designed static foam or dynamic mattress.
If you have a more serious ulcer, you will require a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress itself.
There are also a range of foam or pressure-redistributing cushions available. Ask your carer about the types most suitable for you.
But according to the National Institute for Health and Care Excellence (NICE), there's limited evidence on what kinds of pressure-redistributing devices are best for the relief and prevention of pressure ulcers in different places, such as heels or hips.
Specially designed dressings can be used to protect pressure ulcers and speed up the healing process.
These dressings include:
- alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process
- hydrocolloid dressings – contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy skin dry
- other dressing types – such as foams, films, hydrofibres/gelling fibres, gels and antimicrobial (antibiotic) dressings may also be used
Ask your carer about which type of dressing they're using for the management of your pressure ulcer.
Gauze dressings aren't recommended for either the prevention or treatment of pressure ulcers.
Creams and ointments
Topical antiseptic or antimicrobial (antibiotic) creams and ointments aren't usually recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged or irritated by incontinence.
Antibiotics may be prescribed to treat an infected ulcer or if you have a serious infection, such as:
Diet and nutrition
Eating a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals can speed up the healing process.
If your diet is poor, you may see a dietitian. They can draw up a suitable dietary plan for you.
It's also important to keep up fluid intake to avoid dehydration, as being dehydrated can slow down the healing process.
Removing damaged tissue (debridement)
In some cases, it may be necessary to remove dead tissue from the pressure ulcer to help it heal. This is known as debridement.
If there's a small amount of dead tissue, it may be removed using specially designed dressings.
Larger amounts of dead tissue may be removed using:
- high-pressure water jets
- surgical instruments, such as scalpels and forceps
A local anaesthetic should be used to numb the area around the ulcer so debridement (if not being treated with a dressing) doesn't cause you any pain.
Severe pressure ulcers might not heal on their own. In such cases, surgery may be required to seal the wound, speed up healing, and minimise the risk of infection.
Surgical treatment involves:
- cleaning the wound and closing it by bringing the edges of the ulcer together
- cleaning the wound and using tissue from healthy skin nearby to close the ulcer
Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health.
Risks after surgery include:
- implanted skin tissue dying
- blood poisoning
- infection of the bone (osteomyelitis)
- deep vein thrombosis
Ask your surgeon about the benefits and risks of surgery if it's recommended for you.