The treatment of the last phase of the wounds is very difficult.
In a person who has a terminal illness or multiple chronic diseases, the treatment of decubitus wounds can focus primarily on pain management, rather than completing the healing of a wound.

Treatment of various professionals

To address the various aspects of treating a pest usually serves a multidisciplinary approach.
Members of a health team include:

  • A general practitioner who oversees the treatment plan;
  • A doctor who specializes in the treatment of ulcers;
  • A social worker who helps the person or family to solve problems related to long-term therapies;
  • A physiotherapist who helps improve mobility;
  • A nutritionist who assesses nutritional needs and recommends an adequate diet;
  • A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on the type of surgery that can serve.


Relieve pressure on pressure ulcers

The first step in treating a pressure ulcer at any stage is to relieve the pressure that caused it.
Strategies to reduce pressure are as follows:

  1. Positioning. A person with decubitus sores should be changed position regularly and placed in the correct positions.
    People who use the wheelchair should change positions as much as possible and should be assisted to change positions every two hours.
    It is possible to use lifting equipment for people with disabilities, this prevents friction during the change of position.
  2. Support surfaces. Beds, cushions, anti-decubitus mattresses and special pillows can help a person stay in the proper position, relieve pressure on an existing wound and protect vulnerable skin from damage.
    Several pillows filled with air or filled with water are useful for patients at risk of pressure ulcers.
    There are alternating filler mattresses  (air-inflated), divided into several compartments (one at the feet, one under the back and one under the shoulders).
    A compressor fills one part of the mattress while the other is partially emptied. Then the opposite procedure is done.
    In this way, the weight of the body is first in one area and then in the other. The water mattresses allow to distribute the weight of the body on the mattress in a more homogeneous way according to Pascal’s law.


Remove necrotic tissue from pressure sores

To heal properly, wounds should be without:

  • Infected tissue,
  • Necrotic tissue.

Removal of eschar (tissue that has been necrotic) is performed in several ways, depending on the severity of the wound, the general condition and the goals of the treatment.

Among the options are:

  1. The surgical debridement provides to remove the dead tissue.
  2. The mechanical debridement using one of the methods to soften and remove the wound of debris, such as:
    • Ultrasound ,
    • Versajet

      Versajet , a device that emits a jet of saline solution on the wound to clean and aspirate the fragments. High power becomes a surgical instrument. It gives excellent results, even in a session on a 4th degree plague,

    • Whirlpool
    • Special medications.
  3. Auto-lithium debridement , the body’s natural process of recruiting enzymes to break down dead tissue can be facilitated with a proper medication that keeps the wound clean and moist.
  4. Enzymatic debridement is the use of suitable tissues and chemical enzymes to remove dead tissue.


Treatment for the cleaning of pressure ulcers

The care that promotes the healing of wounds is composed of:

  • Cleaning . It is essential to keep wounds clean and prevent infection.
    A first stage injury can be washed gently with mild soap and water, but the open sores are cleaned with a saline solution every time you change the dressing.
  • Disinfection – Disinfecting products such as beta-dine, acetic acid and hydrogen peroxide, etc., can have a toxic effect and irritate the ulcer.
    Better to use a saline solution or lactated ringer that promote cell proliferation, then repair the ulcer.
    In case of infection (such as diabetic foot ), you can use topical antiseptics or antibiotics.
  • Band Aid. A bandage promotes healing and keeps the wound moist, creating a barrier against infection and leaves the surrounding skin dry.
    Various dressings are available, including:

    • Transparent film , if the lesion does not produce exudate (inflammatory fluid), but may worsen due to friction or the use of adhesive plasters,
    • Hydro fiber, alginate and silver dressings for infected wounds or with a high risk of infection. The alginates can absorb an amount of liquid between 10 and 20 times the weight of them. This type of dressing is done even if the patient takes oral antibiotics.
    • Medication gauze  for wounds with exudate,
    • Gel or hydro gel , has a moisturizing effect and is useful if the wound is dry and sore,
    • Polyurethane foam (creates a damp environment and prevents heat loss). It is used for exuding and sore ulcers.

The dressings adapt to the wound and do not remain raised.
Perianal ulcers should be checked several times a day because there is a high risk of infection.


Other treatments for pressure injuries

Other actions that may be carried out are:

    • Pain management. Treatments that can reduce pain are: administration of anti-inflammatory drugs such as ibuprofen (Alivium, etc.) and naproxen(Naprosyn, Flanax, etc.). In particular they can be taken before and after moving the patient, the debridement procedure and the dressing changes.
  • Topical medications for pain (for example a combination of lidocaine and prilocaine) may be used during dressing changes and debridement.
  • Topical medications , such as riticum vulgare which have a disinfectant effect and serve to promote healing.
  • Antibiotics . Infected decubitus sores that do not respond to other interventions may be treated with topical or oral antibiotics.
    Oral antibiotics are prescribed only in the case of: sepsis, infectious cellulitis or osteomyelitis.
  • Healthy diet . Hydration and proper nutrition promote healing of wounds. Your doctor may recommend:
    • An increase in calories and fluids,
    • A diet rich in protein,
    • An increase in foods rich in vitamins and minerals.
  • The doctor may also prescribe food supplements , such as:
    • C vitamin,
    • Zinc.
  • Relief of muscle spasm . Muscle relaxants can inhibit spasms and allow healing of wounds that otherwise degrade by the friction caused by spasm.
    Among the most prescribed are:

    • Diazepam,
    • Lioresal.


Vacuum assisted closing

The most recent finding for the treatment of decubitus ulcers is vacuum assisted closure, a cure already used in physical therapy to treat some scars (eg Dupuytren’s disease).
It is based on creating a controlled negative pressure on the ulcer.

In practice apply a polyurethane sponge that sticks tightly around healthy skin.
The instrument which aspirates the wound fluid is connected through a tube with the lesion.
Negative pressure promotes blood vessel dilation and improves tissue oxygenation.

Surgical Repair
Decubitus wounds that do not heal may require surgery.

Natural remedies for decubitus ulcers
In the past to remove necrotic tissue larvae and worms were placed on the wounds because they eat the dead tissue and allow the reproduction of healthy cells.
Among her grandmother’s remedies, honey and sugar were once used to cure an ulcer.


Prevention of pressure ulcers

Strategies include:
1. Control skin daily to see changes in skin color.
2. Maintain a proper level of hydration of the skin, damages are most likely if the skin is very dry or very moist.
3. Use moisturizing products to keep skin supple and prevent dryness.
4. Never massage bone areas because the skin is too delicate.

Diet and lifestyle to avoid decubitus ulcers:

1. Feed the person with a healthy and nutritious diet. High blood sugar slows healing, so we recommend avoiding cereals (bread, pasta, pizza, rice, etc.), sweets, potatoes and sugary fruit.
According to hygienism ( natural medicine ), a light diet or a  short fast (if there are no contraindications) promotes tissue healing.
2. Follow the habits of good hygiene.
3. Maintain an appropriate level of activity if possible.
4. Prevent people with decubitus ulcers from smoking.

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