Treating pressure ulcers

Photo of caregiver and patient

Pressure ulcers usually heal if treated carefully. It is crucial that pressure is taken off the wound and that it is protected by a wound dressing. Other treatments such as or surgery may be an option if the wound is healing poorly.

Some pressure ulcers are only on the surface (superficial), while others are very severe and difficult to treat. Smaller pressure ulcers usually heal within a few weeks with proper treatment. But it can take much longer for poorly healing (chronic) wounds to heal.

Pressure ulcers are usually treated at home or in a nursing home. It may be necessary to stay in the hospital if the wounds are severe.

Both doctors and nurses can treat pressure ulcers – but it is the doctor’s responsibility to plan the treatment and to write a prescription for the wound dressings. Many hospitals also have specialists for wound care management who coordinate the therapy.

How can the pressure on the wound be reduced?

A pressure develops if too much pressure is put on one part of the body for too long. Less blood reaches the tissue and it dies. Relieving the pressure can prevent these ulcers. And once a pressure has developed, it can only heal if the pressure is reduced. This can be done by

  • repositioning that part of the body regularly,
  • getting up, walking around and sitting down as much as possible, and
  • using mattresses that are soft or provide alternating pressure.

People who are bedridden are usually repositioned every 2 to 4 hours. If possible, they shouldn’t lie on the pressure . This is hard to prevent for some pressure ulcers, like on the tailbone. It is easier to manage this if the is on a heel, for instance. Then you can place a cushion under the person’s calves.

Mattresses with soft surfaces or alternating pressure help distribute the pressure over a larger body surface area. That relieves the pressure on parts of the body especially prone to pressure ulcers. Special cushions can be used for sitting. In Germany and other countries, health insurers or long-term care insurers cover the costs of many of the aids needed at home if they have been prescribed by a doctor. Family members can also learn various positioning techniques in caregiving courses.

Medical cleaning of wounds and debridement

The wound can be cleaned when the dressing is changed. When medically cleaned, the wound is rinsed – normally using a saline (salt) solution.

In severe pressure ulcers, doctors or nurses also remove dead or inflamed tissue. This is known as . The tissue is removed using instruments such as tweezers, a sharp spoon-like instrument called a curette, or a scalpel. An enzyme-based gel is sometimes applied too, to help clean the wound.

Debridement is often painful. So the area around the wound can be numbed beforehand, for instance with a local anesthetic in a cream. If you think that the pain is going to get really bad, you can also take a painkiller or even have general anesthesia before the starts.

Why are wound dressings a good idea?

Once the wound has been cleaned, it is covered with a dressing. Most wounds are kept moist, Various types of dressings can be used to do this. They include the following:

  • Polymer dressings
  • Hydrogel dressings
  • Hydrocolloid dressings
  • Dressings containing silver or alginates
  • Foam dressings

A dressing is typically left on the wound for a few days. This is done to absorb extra fluid and to prevent . The dressing should be changed if it’s clear that it can’t soak up any more wound secretions, if it slips out of place, or if fluid leaks out of the bandage.

It is now rare to pack a wound with moist gauze because it can stick to the wound and needs to be changed quite often.

What needs to be done if the pressure ulcer doesn’t heal?

A pressure might not heal even if it has been carefully treated with wound dressings, cleaning and repositioning. If a wound doesn’t get any better after two weeks, it’s usually a sign that it’s infected.

The following treatments are used for poorly healing (chronic) wounds:

  • Antibiotics or antiseptics: Antibiotics are usually taken as tablets, but are sometimes applied to the wound in an ointment or placed on the wound using a dressing. Antiseptics are also effective against infections. In addition to antiseptic wound dressings, various antiseptic agents can be used to clean infected wounds.
  • Negative pressure wound therapy: In this type of therapy the wound is covered with an airtight seal. A pump is connected to the a thin tube on the bandage to continuously remove fluid from the wound. This creates a vacuum near the wound, which increases the flow of blood through the wound. It helps keep the wound moist too, which is also meant to improve the healing process.
  • Growth factors: This therapy aims to stimulate the growth of cells. One approach involves putting some of the patient’s own blood into a machine to increase the concentration of blood plasma (platelet rich plasma, PRP). The blood that is prepared in this way is then applied to the wound as a gel. Some studies suggest that can improve healing in chronic wounds such as venous leg ulcers. But there hasn’t been enough research on whether they also help pressure ulcers.
  • Electrical stimulation (electrotherapy): Electrodes are placed on the skin to transmit electrical signals though the body. This is done to improve the flow of blood and help replace dying cells. Studies suggest that electrotherapy can support wound healing.

Ultrasound and electromagnetic therapy are also sometimes used. It is not clear whether they can help chronic wounds to heal better, though.

When is surgery an option?

Surgery is sometimes recommended to treat poorly healing or very severe wounds. The following surgical procedures are used:

  • Skin graft: In this procedure, skin is taken from another part of your body – usually your thigh – and transplanted onto the wound. This skin connects to the surrounding tissue and closes the wound.
  • Skin flap: The pressure is removed. The missing tissue is replaced by grafting or moving tissue from the body, such as subcutaneous fatty tissue or muscle flaps. That may include neighboring tissue or tissue from other parts of the body. Tissue from the pelvis, buttocks or thighs is commonly used in this procedure.

It usually takes a few weeks for the skin to heal after one of these procedures.

How can you deal with the pain?

Wound pain can make daily life hard, cause sleeping problems and also be extremely difficult emotionally. The pain can wear you down and even make you feel depressed over time.

Proper wound care and the right positioning can prevent pain or at least reduce it. If that isn’t enough, medication such as acetaminophen (paracetomol) or ibuprofen can relieve mild to moderate pain. Some dressings contain painkillers too. Doctors can prescribe stronger painkillers as needed.

It is important for medical professionals to take care to keep the pain as low as possible when changing the bandage – for instance by using wound dressings that don’t stick as much to the wound. Another option is to rinse the wound with a salt solution first, so the dressing comes off more easily.

People who have chronic pain can benefit from pain management therapy and psychological support. The aim of psychological treatments for pain management is to help people cope better with the pain in everyday life.

Arora M, Harvey LA, Glinsky JV et al. Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev 2020; (1): CD012196.

Chen J, Wan Y, Lin Y et al. Platelet-rich fibrin and concentrated growth factors as novel platelet concentrates for chronic hard-to-heal skin ulcers: a systematic review and Meta-analysis of randomized controlled trials. J Dermatolog Treat 2022; 33(2): 613-621.

Deutschsprachige Medizinische Gesellschaft für Paraplegie (DMGP). Querschnittspezifische Dekubitusbehandlung und -prävention (S1-Leitlinie). AWMF-Registernr.: 179-008. 2017.

European Pressure Ulcer Advisory Panel (EPUAP). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide (QRG). 2019.

Furuya-Kanamori L, Walker RM, Gillespie BM et al. Effectiveness of Different Topical Treatments in the Healing of Pressure Injuries: A Network Meta-analysis. J Am Med Dir Assoc 2019; 20(4): 399-407.

McInnes E, Jammali-Blasi A, Bell-Syer SE et al. Support surfaces for treating pressure ulcers. Cochrane Database Syst Rev 2018; (10): CD009490.

Qu W, Wang Z, Hunt C et al. The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis. Mayo Clin Proc 2021; 96(9): 2407-2417.

Shi C, Dumville JC, Cullum N et al. Beds, overlays and mattresses for treating pressure ulcers. Cochrane Database Syst Rev 2021; (5): CD013624.

Snyder D, Sullivan N, Margolis D et al. Skin Substitutes for Treating Chronic Wounds. (AHRQ Technology Assessment Program). 2020.

Zens Y, Barth M, Bucher HC et al. Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials. Systematic Reviews 2020; 9(1): 238.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on August 19, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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