8.4.1 Treatment of pressure ulcer stages Listen

Treatment of grade 1 pressure ulcers

Grade 1 damage does not necessarily require a dressing. The area of damage should be off-loaded and inspected regularly. A film may be applied to the area, but generally a dressing is only recommended if the skin becomes broken.

Treatment of grade 2 pressure ulcers

Clean the area if necessary with sterile saline. A hydrocolloid or foam dressing can be applied to absorb any exudate. The dressing can be changed every 3-5 days. Barrier film can be applied to the surrounding skin prior to the application of the dressing.

Treatment of grade 3 pressure ulcers

Like grade 2 ulcers, they too can be cleansed with sterile saline and dressed with a hydrocolloid or foam dressing depending on the size and depth of the ulcer. A deep and heavily exuding grade 3 ulcer may require the use of an alginate or hydrofibre dressing, with a foam being used as the secondary dressing of choice. Antibacterial dressings can be used in the case of infected pressure ulcers, but prolonged use is not advisable.

Treatment of grade 4 pressure ulcers

Clean the area with sterile saline. Dress the cavity with an alginate or aquafibre dressing. Antibacterial dressings can be used in the case of infected pressure ulcers, but prolonged use is not advisable.

Grade-4 ulcers will have bone present in the wound bed. It is important to observe for signs of osteomyelitis in these ulcers.

The aim of treatment is to create an optimal healing environment. This is done with a stable, solid vascularised wound bed with minimal exudates. The wound bed must be optimised by removing necrosis and debris and preventing infection.

Local guidelines and the tissue viability team should be consulted in the management of pressure ulcers.


Pressure ulcer stage I: at this point the sore will not necessarily require a bandage. The area of damage should be offloaded and inspected regularly.
Pressure ulcer stage II: a dressing can be applied at this stage if the wound is producing exudate.
Pressure ulcer stage III: the wound effects the outer soft tissue, and may produce a lot of exudate.
Pressure ulcer stage IV: the wound effects the underlying muscle and skin tissue, and bone can be present in the wound bed.