ABSTRACT
PATHOPHYSIOLOGY OF PRESSURE ULCERS Pressure ulcers refl ect patients’ systemic health in addition to their physical, nutritional, social, and psychological status. The complex pathophysiology of pressure ulcers suggests that several processes are involved in the evolution of these ulcers. The sustained pressure force or shear force over the soft tissue in between the body mass, bony process, and surface initiates this complex process. This is followed by a reduction in the capillary vessel fl ow, occlusion of the blood vessel and lymphatic vessel, and capillary thrombosis. Tissues become ischemic under these conditions, as a result of which capillary permeability increases and fl uid is collected in the third space (extravascular space). The edematous tissues so formed may result in necrosis, which is irreversible. Once the tissue develops necrosis, the extent of debridement needed should be determined. Surgical intervention can be initiated after determining when to evaluate the necrosis of tissue and how to effectively remove the necrotic tissue from the surrounding healthy tissue (Figure 15.1).
