Clinical presentation and diagnosis

Approximately two-thirds of all pressure sores occur on the sacrum and heels. The remaining third occur predominately on the elbows, ankles, trochanters, ischia, knees, scapulas, shoulders, or occiput.45 Pressure sores are classified according to the extent of tissue destruction.46 The most commonly used system for staging of pressure sores is presented in Table 73-7.

Bacterial colonization of pressure sores is common. Because infection impairs wound healing and may require systemic antimicrobial therapy, the clinician must be able to distinguish it from colonization. Table 73-8 describes the clinical presentation of infected pressure sores.

Most complications are infectious. The most common is osteomyelitis, which

is present in approximately 38% of infected pressure sores. Less frequently, NF, clostridial myonecrosis, and sepsis can occur.

Table 73-7 Staging of Pressure Ulcers

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