2. Pressure ulcer

3. Pressure ulcer definition
A pressure ulcer is localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

4. Pressure Ulcer Etiology
Pressure exerted by bony prominences on the body that stop capillary flow to the tissues.
Deprives tissues of oxygen and nutrients causing cell death.
Pressure greater than capillary closing pressure exerted by bony prominences to disrupt blood flow.

5. Sacrum ( most common site) Ischial tuberosity . Heels
Most Common Sites
Sacrum ( most common site)
Ischial tuberosity .
Heels

6. Pressure Ulcers from other sources of pressure
Boots/boot straps
Plaster casts
Heel protectors/protector straps
Oxygen tubing
Anti-Embolism Stockings
Compression bandaging
Any device that can lead to pressure induced ischemia on the skin

7. Pressure Friction Shear Moisture Malnutrition Neurologic injuries
Basic Science
Pressure
Friction
Shear
Moisture
Malnutrition
Neurologic injuries

8. Pressure
pressure sores are thought to result from pressure applied to soft tissue at alevel higher than that found in the blood vessels supplying that area for an extended time period.

9. pressure roughly double capillary closing pressure, applied for 2 hours, resulted in irreversible ischemic damage to tissue.

10. Friction & shearing

11. Friction lesions

12. Moisture Moist skin has a higher coefficient of
friction and is prone to maceration and excoriation

13. While some studies have found a relationship between urinary incontinence and pressure sores , others have failed to find a correlation while noting a significant correlation with fecal incontinence.

14. Dry Skin
While excess moisture is clearly deleterious, the opposite is also true. Excessively dry skin is prone to cracking, has decreased tensile strength and lipid content, and impaired barrier function, and appears to be an independent risk factor for pressure ulceration.

15. Malnutrition
There is certainly a strong correlation between malnutrition and pressure sores, but a clear causal link remains elusive

16. Neurologic Injuries
pressure sores remain the most common complication and the second most common cause of hospital admission in the SCI population. Immobility, either in bed or in a wheelchair , leads to increased pressure, friction, and shear that is a causative factor in all pressure sores.

17. Grading
Grade I : Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may be indicators, particularly with darker skin.
Grade II : Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents as an abrasion or blister.

22. Grade III :Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
Grade IV : Extensive destruction, tissue necrosis or damage to muscle, bone of supporting structures, with or without full thickness skin loss

27. Pressure Areas In Wheelchairs