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The Role of Wound Bed Preparation in Managing Chronic Pressure Ulcers

Romanelli M, Mastronicola D (2002) The Role of Wound Bed Preparation in Managing Chronic Pressure Ulcers, Journal of Wound Care 11 (8)



Studies examining the prevalence, incidence and distribution of pressure ulcers have been relatively well documented. The principal cause of pressure ulceration is the application of localised pressure to an area of the skin not adapted to this external force, although the entire pathology and aetiology is multifactorial. The precise mechanisms leading to tissue breakdown and ulceration remain unclear. However, three pathophysiological processes have been suggested: Occlusion of skin blood flow and subsequent injury due to the sudden reperfusion of the vascular bed; Tissue breakdown as a result of damage to aeterioles and the microcirculation due to the application of friction and shearing forces; Direct occlusion of blood vessels by external pressure for a prolonged period, resulting in cell death. The intensity and duration of pressure is critical, as is the tolerance of the skin and its supporting structures to pressure. At an individual level, pressure ulcers develop as a result of the interaction between these two elements.