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Treatment Options for Pressure Ulcers

David’s coccyx has opened is has now been graded a stage II pressure ulcer according to the Braden Scale. He has been referred to the Wound Clinic at the rehabilitation facility and the physiatrist has decided to dress his wound and apply electrical stimulation.

What is the evidence supporting the use of dressings for the treatment of pressure ulcers in individuals with SCI?

There is level 1 evidence from a single RCT that completion of healing for stage I and II pressure ulcers is greater with an occlusive hydrocolloid dressing compared to phenytoin cream or simple dressing post SCI.

There is level 2 evidence from a single, small RCT that occlusive hydrogel-type dressings heal more pressure ulcers than conservative treatment post SCI.

There is level 1 evidence that topical phenytoin shows a trend towards healing of stage I and II pressure ulcers post SCI

There is very limited level 3 evidence that the use of a normothermic dressing may improve healing of pressure ulcers post SCI.

SHOW ME THE EVIDENCE

Occlusive hydrocolloid dressings are useful for healing of stage I and II pressure ulcers post SCI.

Use of a normothermic dressing may improve healing of pressure ulcers post SCI but more research is needed.

 

What is the evidence supporting the use of electrical stimulation for the treatment of pressure ulcers in individuals with SCI?

There is level I evidence from 2 RCTs to support the use of electrical stimulation to accelerate the healing rate of stage III and IV pressure ulcers when combined with standard wound management. 

SHOW ME THE EVIDENCE

Electrical stimulation should be added to standard wound management to promote healing of Stage III and IV pressure ulcers post SCI.

More research is needed to determine which type of electric current and application protocol will result in better healing of pressure ulcers post SCI.

 

 What alternative methods are available for treating pressure ulcers in persons with SCI?
  • Laser Energy– There is level 1 evidence (from two RCTs) to suggest that laser treatment has no added benefit in pressure ulcer healing post SCI than standard wound care alone.
    SHOW ME THE EVIDENCE

     
  • Ultrasound/Ultraviolet Light– There is level 1 evidence, from 1 small RCT, to suggest that combining US/UVC with standard wound care decreases wound healing time of pressure ulcers post SCI but no evidence to clarify whether UVC or US, used alone, have a beneficial effect.
    SHOW ME THE EVIDENCE

     
  • Non-Thermal Pulsed Electromagnetic Energy– There is level I evidence from one small RCT to support the efficacy of pulsed electromagnetic energy to accelerate healing of stage II and III pressure ulcers post SCI.
    SHOW ME THE EVIDENCE

     
  • Topical Negative Pressure – There is very limited level 4 evidence that topical negative pressure improves healing of pressure ulcers post SCI.
    SHOW ME THE EVIDENCE

     
  • Anabolic Steroid Agents– There is very limited level 4 evidence to support the use of anabolic steroid agents (oxandrolone) to promote healing of stage III and IV pressure ulcers post SCI.
    SHOW ME THE EVIDENCE
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  • Recombinant Human Erythropoietin – There is very limited level 4 evidence suggesting the use recombinant human erythropoietin aids in the healing of stage IV chronic non-healing pressure ulcers post SCI.
    SHOW ME THE EVIDENCE

     
  • Maggot Therapy– There is level 2 evidence from one very small study to support the use of maggot therapy as an adjunctive therapy for non-healing stage III and IV pressure ulcers post SCI.
    SHOW ME THE EVIDENCE

     
  • Topical Oxygen– There is very limited level 4 evidence that topical oxygen therapy may improve healing of pressure ulcers post SCI.
    SHOW ME THE EVIDENCE