Geriatric Quick Consult      Pressure Ulcers      Do #5

Be aware of potential complications.

Knowledge Action
Potential complications of pressure ulcers include: osteomyelitis, bacteremia, cellulitis, sinus tracts or abscesses, perineal-urethral fistula, septic arthritis, maggot infestation, amyloidosis, endocarditis, heterotopic bone formation, pseudoaneurysm, meningitis, squamous cell carcinoma in ulcer.

The most common complication of pressure ulcers is infection.

Even a small skin opening can communicate with a deep abscess crater or extensive sinus tracking.

Pressure ulcer-associated bacteremia is infrequent but has a high mortality.

Necrotic tissue is a good medium for bacterial growth.

Local control of infection begins with debridement.

Systemic antibiotics have little effect on wounds colonized with skin flora.

Antibiotics should be reserved for infectious complications (e.g., sepsis, osteomyelitis, cellulitis).

Topical antiseptics (e.g., povidone-iodine, hydrogen peroxide) are toxic to healthy growing tissue, and should not be used.
  • Review all potential complications.


  • Examine wound thoroughly.


  • Remember "late" complications in chronic wounds:


    • Squamous cell carcinoma.

    • Systemic amyloidosis


  • Look for deep infections draining through small sinus tracts.

Reference:

  1. Bergstrom N, Bennett A, Carlson CE, et al. Clinical Practice Guidelines Number 15: Treatment of pressure ulcers.
  2. Ferrell BA. Pressure ulcers. In Ham RJ, Sloane PD, Warshaw GA. Primary Care Geriatrics, 4th ed. St. Louis: Mosby, 2002.
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