J. Javier Soldevilla Agreda

A New Theoretical Model for the Development of Pressure Ulcers and Other Dependence‐Related Lesions

OBJECTIVE To review the risk factors included in pressure ulcer risk assessment scales and construct a theoretical model for identifying the etiological factors of skin ulcers, excluding those of systemic origin (e.g., venous, arterial, and neuropathic). METHODS Consensus study with expert panel (Delphi Method) based on a structured review of the literature. A search was conducted of the main databases between 1962 and 2009 with no language limitations. All descriptive or validation studies were included, but the grey literature was excluded. After identifying the risk factors in each scale, they were grouped into risk dimensions as a basis for constructing a new theoretical model. RESULTS Eighty-three risk factors were identified in the 56 scales reviewed, and the risk factors were then classified by the expert panel into 23 risk dimensions. These dimensions were used to construct a new theoretical model (middle-range theory) for chronic wound development that explains the production mechanism of seven types of lesion: moisture, pressure, friction, combined pressure-moisture, combined pressure-friction, multifactorial lesions, and coadjuvant factors. These lesions were generically defined as dependence-related injuries. CONCLUSIONS Based on the classification of risk factors from the different scales into risk dimensions, a new middle-range theory was constructed that explains the production mechanism of seven dependence-related lesions considered to date as pressure ulcers. CLINICAL RELEVANCE The prevention and treatment of these lesions requires a correct diagnosis and differentiation of their cause and management of the risk dimensions involved. The type of lesion also influences the selection of local approach.

Classification of dependence-related skin lesions: a new proposal

A new theoretical framework on the development of pressure ulcers and other dependence-related lesions requires continued in-depth analysis of their conceptual bases. This study reports the historical background, definitions, and production mechanisms of these lesions, describing the differential pathognomonic features of pressure and/or shear ulcers, moisture-associated skin damage, and lesions from rubbing or friction. It also discusses the combined/multifactorial lesions that can be found in the clinical setting. Finally, it presents the new classification of these lesions proposed by the Spanish Pressure Ulcers and Chronic Wounds Advisory Panel.