Injury may prevent the normal movement essential for preventing tissue ischaemia from local pressure. Tissue necrosis may begin within the first few hours on injury. Commonly, the ischial tuberosities, the sacrum, the greater trochanters, the heels, and less frequently, the shoulders and elbows, are sites at risk.
Prevention is achieved by dispersing the pressure evenly over the body surface. Repeated turning, or an air pressure bed are the most common means. During wheelchair rehabilitation, a special cushion such as a Roho cushion is essential.
Established sores must be debrided of necrotic tissue, often with the aid of a desloughing agent such as Eusol. Smaller sores may heal simply by the avoidance of further pressure. Surgery may be indicated if there is infected bone at the base of the sore. Topical antibiotics such as gentamycin beads, may occasionally be used to eradicate infection after closure.
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