Treatment

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