Pressure Ulcer Evidence Based Treatment Pathway

This Pressure Ulcer Evidence Based Treatment Pathway is based from documents such as the NPUAP/EPUAP and WOCN guidelines. I have revised them in a time related format that is based on predictive modeling evidence.

Week 1 Pressure Ulcer Evidence Based Treatment Pathway

  1. Relieve Pressure                              Support Surfaces / Other Offloading Devices
  2. Manage Infection                            Culture / Antimicrobials
  3. Remove Avascular tissue              Debride (Leave heel wounds intact unless infected)
  4. Optimize Nutrition                          Pre-albumen / Dietary consultation
  5. Control Moisture                             Absorbent dressing
  6. Reduce Healing Delays                  Treat Co-morbid Conditions
  7. Fill Dead Space                                  Fill to volume of wound (Don’t over pack)
  8. Resolve aggravating conditions  Treat friction, shear, moisture, and incontinence
  9. Sponsor Granulation                      Consider NPWT

Week 4 Pressure Ulcer Evidence Based Treatment Pathway – If the pressure ulcer heals less than 75% over the first 4 weeks* then consider the following adjunctive therapies or treatments:

  1. Sponsor Granulation                      NPWT (Revisit use if not previously ordered)
  2. Fill volume                                          Apply Dermal substitutes
  3. Revise tissue                                      Surgical Intervention
  4. Treat Chronic Conditions              Debride and Treat with Collagen

10 Week Benchmark: The median days to healing is 73 days for large (>4cm2) ulcers¹.

* Note: Wounds that did not decrease in area by 77% after 4 weeks were significantly less likely to  heal² (a 75% closure rate at 4 weeks was selected due to wound measurement conventions)


  1. Bergstrom et al., 2008.  NPUAP & EPUAP. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Pg 54.
  2. Van Rijswijk L. Full-thickness pressure ulcers: patient and wound healing characteristics. Decubitus. 1993;6:16–2

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