 Bed sores are the visible evidence of pathologic changes in the blood supply to dermal tissues  Main cause – pressure or force applied to susceptible tissues  Hence concentrated wherever weight bearing points come in contact with surfaces

 About 95% - lower part of the body  Most frequent – Sacrum followed by heel

 Elderly  Bed ridden patients with extensive skin involvement › SJS/TEN › Pemphigus

1. Turn and position the patient frequently (no time limit) 2. Pressure reducing/relieving devices – air mattresses 3. Proper nutrition (high protein diet) - Bed sores relatively more common in malnourished patients (twice as likely) when compared to nonmalnourished patients

4. Provide good skin care - moisture macerates and injures skin - keep the area dry especially in patients with incontinence (urinary or fecal) - keep the bed clean (food crumbs, iv tubing, other debris in the bed can greatly increase local skin pressure)

1. Relieve pressure, friction, shear - Air-fluidized beds 2. Optimize wound therapy - Occlusive dressing enhances wound healing - Moist environment provided by occlusion increases the epithelization rate

 Occlusive dressings: - Polymer films - Hydrocolloid dressing - Hydrogels - Saline soaked gauze : a good/cost effective alternative if not allowed to dry

3. Remove necrotic debris which increases chances of bacterial infection and delays wound healing - Wound cleansing with antiseptic solutions e.g povidone iodine(Betadine), hydrogen peroxide, acetic acid etc. should be avoided as they destroy granulation tissue

4. Manage bacterial contamination - look for signs of infection- erythema, edema, odor, fever or purulent exudatec - Foul odor – anaerobic org - topical antibiotics like silver sulphadiazine if wound fails to progress towards healing - for anaerobic infection – topical metronidazole

5. Correct nutritional deficits - higher protein intake - Role of Zinc, Vitamin supplementation is controversial but may be helpful