chapter  13
14 Pages


WithCarlos A. Charles, Anna F. Falabella

Pressure ulcers are a common, serious, and expensive medical problem, imposing a significant burden on the health care system. Of historical significance, pressure ulcers have been reported since the time of Egyptian mummies (1). In the early 1800s Brown-Sequard (2) suggested that skin pressure and prolonged moisture were the most essential etiologic components in the development of pressure ulcers, this idea stemmed from experiments in which animal spinal cords were transected and ulcers were not produced as long as the animal skin was maintained dry. Subsequently, in 1873, researchers suggested that pressure ulcers were caused by the sloughing and mortification or death of tissue produced by continual pressure (3). While Charcot introduced the pessimistic belief that pressure sores occurred in all paraplegic patients, and that they are inevitable in anesthetic skin, therapeutic interventions during World War I demonstrated that pressure ulcers could be prevented and successfully treated (4). These modalities were further explored over time, and World War II provided the impetus for the beginnings of modern reconstructive surgical approaches to wound healing (5). As research has evolved, investigators have further pursued both surgical and noninvasive approaches to better understand the pathophysiology and successful therapeutic interventions for pressure ulcers. Most importantly, researches and clinicians alike have begun to recognize the role and biomechanics of pressure as a direct cause of ulcer formation and this has led to a concerted effort towards prevention, which remains the foundation for successful clinical outcomes.