Off-loading Effects on Pressure Ulcer Healing Time

The most effective way to heal a pressure ulcer is to decrease or remove the pressure that caused it. There are varying degrees of off-loading, from pressure redistribution with cushions and bed overlays, to total off-loading through bed rest.  For many reasons, patients are hesitant to commit to complete or near-complete bed-rest or off-loading plans for wound healing.  The following cases contrast the slow rate of healing in patients who initially did not commit to off-loading with the rapid progress observed once an off-loading commitment was made.

Case #1:  Ischial wound with exposed bone in paraplegic patient presented for treatment 4/2013.  Nutrition and appropriate wound care initiated with intermittent bed-rest alternated with periods of time in wheelchair with appropriate cushion.   No change in wound size through 7/2013.  Complete bed-rest began 8/23/2013.  Wound >50% healed within 2 months.

Case #2:  Sacral pressure ulcer in spina bifida patient presented for treatment in 3/2011.  Appropriate wound care with no off-loading commitment from patient through 8/2011.  Patient lost hours at work and committed to more time in bed.  Wound closed within 2 months.

Case#3:  Elderly patient with stage 4 pressure ulcers to bilateral trochanters presented for treatment 12/2011.  Wound care and nutrition addressed.  Wounds with small improvement until 1/2012 when off-loading devices arrived in the home.  April, 2012 left ischial wound closed and right ischial wound with significant improvement.