Adjuvant therapy for pressure ulcer management

Numerous physical agents offer benefits to patients in contributing to wound healing. The use of subatmospheric pressure to promote wound healing has been increasing in the treatment of pressure ulcers. Originally, placing polyurethane foam dressings covered with adhesive tape created a controlled closed wound. We applied a drain pouch instead of form dressing. The six Stage IV ulcers treated with pockets were located in the patient's sacrum and great trochanteric area. The treatment consisted of application of the drain pouch around the wound connected to a negative pressure device by suction hose. The device operated continuously at a negative pressure of 18 mm Hg. In one case, the closed wound could not be maintained because of a very large ulcer area. Successful closure of the sacral ulcer occurred in two patients by direct granulation, while two wounds underwent secondary closure following granulation. One patient died before definitive wound closure due to a cardiac arrest. The results are encouraging and further additional clinical studies are warranted. This article will also review adjuvant therapies, electrotherapy, hyperbaric oxygen, ultrasound, and hydrotherapy, electric stimulation, phototherapy, pulsed electromagnetic energy and heat as means to promote wound healing.