Hesperian Health Guides
Treatment of Pressure Sores
Watch for the first signs of a pressure sore by examining the whole body every day. Teach the child to do this using a mirror.
For larger areas (like the bones near the base of the spine), you can try using a small (motor scooter) inner tube to keep weight off the sore area. Put a towel over the tube to soak up sweat. (Sweaty skin against the rubber can also cause sores.)
Papaya has enzymes (chemicals) that digest dead flesh. Cooks use it to soften meat. The same enzymes can help soften the dead flesh in a pressure sore, and make it easier to remove. First clean and wash out a pressure sore that has dead flesh in it. Then soak a sterile cloth or gauze with ‘milk’ from the trunk or green fruit of a papaya plant and pack this into the sore. Repeat cleaning and repacking 3 times a day.
If early signs of a sore appear (redness, darkness, swelling, or open skin), change body positions and use padding to protect that area from pressure.
WARNING!
| For small areas such as heels, never use a ring or ‘donut’ of cloth to keep weight off the sore. This can cut off blood supply to the skin inside the ring and make the sore worse. |  NO! |
IF A PRESSURE SORE HAS ALREADY FORMED:
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| This young man with paraplegia has a large pressure sore on his butt. Until it heals, he must not sit. Village rehabilitation workers made this wheel lying cart for him to move about on. Here he helps a boy learn to walk. (Photo, John Fago) |
- Keep pressure off the sore area completely and continuously.
- Keep the area completely clean. Wash it gently with clean or boiled water twice a day. Do not use alcohol, iodine, merthiolate, or other strong antiseptics.
- Eat well. If lots of liquid comes out of the sore, a lot of protein and iron are lost with it. These must be replaced for quicker healing. Also take iron pills if signs of anemia are present. Eat foods rich in protein: beans, lentils, eggs, meat, fish, milk products.
- Do not rub or massage areas where pressure sores might be forming. This could tear weakened flesh and make the sore inside bigger.
IF A SORE IS DEEP AND HAS A LOT OF DEAD FLESH:
 open sore | |
| Dead flesh—may be gray, black, greenish, or yellowish. It may have a bad smell if infected. | |
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A large plastic or glass syringe works well for washing out the sore. Wash the syringe well with soap and water after each use. |
- Clean the sore 3 times a day.
- Each time, try to scrape and pick out more of the dead rotten flesh. Often, you will find the sore is much bigger inside than you first thought. It may go deep under the edges of the skin. Little by little remove the dead flesh until you come to healthy red flesh (or bone!).
- Each time after cleaning out the dead flesh, wash the sore out well with soapy water. Use liquid surgical soap if possible. Then rinse with clean (boiled and cooled) water.
If the sore is infected (pus, bad smell, swelling, redness, hot area around the sore, or the person has fevers and chills), get help from an experienced health worker and:
- Clean out the sore 3 times a day as described. Wear clean gloves while cleaning or filling the pressure sore, applying new bandages,and disposing of the used bandages. Sterilze bandages to be reused or put them into a plastic bag and bury it. See Chapter 19 for information on handling anything with blood or body fluids on it.
- Take the person to a clinical laboratory for a culture to find out what germs are causing the infection and what medicine will fight it best.
- If this is not possible, try treating the person with the antibiotics shown in the box below.
- If the sore does not get better, or keeps draining liquid or pus from a deep hole, the bone may be infected. In this case, special treatment is needed. Take the person to a capable medical center (see Chapter 19.)
| TREATMENT OF INFECTED PRESSURE SORES | |||
|---|---|---|---|
| Name of medicine | Age or weight | Dose | How to take |
| Cephalexin (Keflex) | 1 month to 11 years | 25 mg/kg | By mouth, 2 times a day for 7-10 days |
| 12 years and older | 1 g | ||
| OR | |||
| Amoxicillin + clavulanic acid (Augmentin) | up to 40 kg | 25 mg amoxicillin + 3 mg clavulanic acid / kg | By mouth, 2 times a day for 7-10 days |
| 40 kg and over | 1 g amoxicillin + 125 mg clavulanic acid | ||
| OR for persons allergic to penicillin: | |||
| Clindamycin (by mouth) | all children | 10 mg/kg | By mouth, 3 times a day for 7-10 days |
Two traditional treatments that help in curing pressure sores
PAPAYA (PAW PAW)
HONEY AND SUGAR
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| A village rehabilitation worker treats a young man’s pressure sores with a paste made by mixing honey and sugar. |
Once a pressure sore is free of dead flesh, filling it 2 to 3 times a day with honey or sugar helps prevent infection and speeds healing. This treatment, used by the ancient Egyptians and recently rediscovered by modern doctors, works remarkably well. It is now being used in some American and British hospitals.
To make filling the sore easier, mix honey with ordinary sugar until it forms a thick paste. This can easily be pressed deep into the sore. Cover the sore with a thick gauze bandage.
CAUTION! It is important to clean out and refill the sore at least 2 times a day. If the honey or sugar becomes too diluted with liquid from the sore, it will feed germs rather than kill them.
Molasses can also be used. In Colombia, South America, doctors shave thin pieces off blocks of raw sugar and put these into the sore.
This page was updated:04 Apr 2024