Once a pressure ulcer has begun it is important to prevent it from worsening and ultimately to have it heal quickly but this is challenging. Rappl (2008) examined the metabolic and physiological changes that happen in tissue below the level of a SCI in relation to the events which take place during wound healing. The author examined that every step of wound healing is affected by the physiological changes that occur post SCI explaining why pressure ulcers may heal more slowly in individuals with a SCI. As previously stated, severe pressure ulcers can lead to further disability, surgery, amputation and death (Krause 1998). According to Chen et al. (2005) pressure ulcers are among the leading cause of unplanned rehospitalization post SCI and can contribute to longer lengths of stay and more costly treatment than other medical conditions. Once an individual has had an ulcer they are at increased risk for recurrence (Krause & Broderick 2004; Verschueren et al. 2011). Pressure ulcer treatment is more costly than prevention (Bogie et al. 2000; Jones et al. 2003). In addition to standard wound care, many adjunctive therapies are used to accelerate closure of wounds that are hard to heal. It is important to identify appropriate clients, through appropriate and regular assessment, who are likely to benefit for these treatments as they are often time consuming and expensive (Houghton & Fraser 2008; Allen & Houghton 2003).
Research has examined the effect of a variety of therapies on pressure ulcer healing including electrical stimulation, laser, ultrasound, non-thermal pulsed electromagnetic energy, topical negative pressure, normothermia, recombinant human erythropoietin, anabolic steroid therapy, dressings, maggot therapy, topical oxygen, surgery, and herbal remedies; each of these treatments will be discussed in subsequent sections.