[Decubitus sores in geriatric medicine. Local and general treatment of pressure sores in the aged].

UNLABELLED: LOCAL CARE: Local antiseptics and antibiotics must be avoided to preserve the local bacterial ecosystem of the wound. If surgical debridement is not possible, hypercolloid, alginate or hydrogel dressings should be applied to achieve natural autolytic cleansing. The budding and epithelization phases are also treated either with oily or humid dressings or more modern hypercellular, hydrocolloid and polyurethane film dressings. Other treatments under evaluation include physical means (negative pressure, electrical stimulation) or use of recombinant growth factors.

GENERAL TREATMENT: Surgical repair with flaps or grafts is not usually indicated in fragile elderly patients. Special attention must be given to all associated diseases (diabetes, heart failure, etc.) as well as protein-calorie nutrition. The objective is 35 cal/kg/d including 1.25-1.5 g protein/kg/d. TREATMENT OF COMPLICATIONS: Wound infection should be suspected in case of an inflammatory induration around the wound, fever, or delayed healing. Systemic antibiotics are indicated as for cellulitis. The wound is generally colonized by germs found on local bacteriological samples. Osteitis should be suspected if the wound is in contact with bone. In case of biopsy proven osteitis with positive culture, prolonged oral antibiotics are indicated. Tendon retractions should benefit from rehabilitation exercises and surgery in case of medical failure. Antalgesics may be required, either continuously or when making the dressings.