The Evolution of Pressure Injury Treatment

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Patients and their caregivers have struggled with the affliction of pressure injuries throughout the millennia. Even today, these painful wounds represent a significant clinical, quality of life and economic challenge for the health care community. Early evidence of pressure injuries has been found in Egyptian mummies dating back 5000 years.

The scientific understanding of the causes and progression of pressure sores has grown dramatically in the intervening centuries, leading to significant advancements in prevention and treatment strategies. The earliest treatment focused on cleaning and bandage the wound. To this end, Jayesh Shah notes in The History of Wound Care that the Greeks used boiled water and vinegar as an antiseptic, and the Egyptians concocted dressings from vegetable fiber, grease, and honey. It is thought that the fiber helped to absorb wound drainage, while honey functioned as an antibacterial and animal fat provided a barrier to infection. Although these early remedies relied on primitive materials, many of the underlying principles of wound management remained in place through the last century. Today’s more sophisticated understanding of the biology of wound healing has led to more effective pressure sore treatment as well as novel prevention strategies.

By the 1800’s physicians had correctly surmised that excessive pressure on a body part that cuts off circulation by compressing the blood vessels will lead to tissue death in the affected area.  This understanding spawned the realization that not all pressure sores are inevitable injuries. As this article in the Indian Journal of Plastic Surgery notes, over the next several decades, other important contributing factors such as friction, shear, moisture, nutrition, and infection were also identified. 

Staging systems to define the anatomical damage from a pressure sore has also evolved as greater clinical knowledge and advanced imaging techniques have become available. The 4-stage system widely used today was first developed in 1989 by the National Pressure Injury Advisory Panel (NPIAP). The group has continued to update the system through the years by adding language to help better identify pressure wounds in dark skinned patients, and to expand upon the role of deep tissue injury (DTI) as precursor to pressure injury formation.

Related: See our resource on pressure injury prevention & treatment in healthcare facilities.

As knowledge of the etiology and natural history of pressure sores evolved, much of the emphasis has shifted to prevention measures. Therapeutic support surfaces such as sheepskins, overlays, cushions, and specialty designed mattresses are routinely used to protect vulnerable parts of the body and distribute the surface pressure more evenly. Low-tech versions of these include mattresses filled with foam, fluid, beads or air; and alternative foam mattresses and overlays. High-tech solutions feature mattresses and overlays that are electrically powered to alternate the pressure within the surface, beds that are powered to have air mechanically circulated within them, and low-air-loss beds that contain warm air moving within pockets inside the bed. 

The Airisana™ Therapeutic Support Surface was designed to build on these advancements to provide a cutting-edge approach that incorporates all the best practices in pressure injury prevention. Unlike traditional support surfaces that use a repeating pressure pattern, Airisana™ employs randomized pressure therapy algorithms to prevent adaptation and promote sustained healing. This targeted air system also supports the management of the skin’s microclimate to eliminate moisture without excessively drying or cooling the patient’s skin.  In addition, Airisana™ is designed to safely support the multiple bedside therapies seriously ill patients often require. Click here to learn more about the Airisana™ 5-in-1 solution for pressure injury prevention.

How Nurses Lead the Way in Reducing Pressure Injuries


Pressure Injuries

Michelle Daniels
Michelle Daniels is the Managing Director, TPF & TSS Brands for Encompass Group. She can be reached at

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