الفهرس 
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Abstract
Pressure ulcers has social and psychological effects which contribute to a reduce quality of life. It can cause psychological trauma as depression, shame andembarrassment.
Pressure ulcers (PUs) are localized injury to the skin or underlying tissue usually over bony prominence, as a result of pressure with or without shear or friction.
Early studies demonstrated that pressure of 70 mm Hg applied over 2 hours was sufficient to cause pathologic changes in dogs
The incidence of PUs formation is about 9% of all hospitalized patients mostly in association with other medical problems, including cardiovascular disease (41%), acute neurologic disease (27%), and orthopedic injury (15%).
Usually its occurrence due to combination of extrinsic factors such as pressure, shear, and friction and intrinsic factors such as age, malnourishment, and consciousness level that influence a person’s tissue tolerance.
PUs are classified by the level of visible tissue damage, where stage I PUs is non blanchable erythema on intact skin, stage II PUs are partial thickness ulcers, and stages III and IV ulcers involve full-thickness damage.
Our study is a retro and prospective study including 42 patients with 57 bed sores with different types of bed sores (ischeal , trochanteric and sacral ) and different degrees of severity (3rd and 4th degree) .
In our study the main etiology of bed sore was road traffic accident that lead to bedridden in these patients (40%), stroke in 15 patients that lead to paraplegic in these cases (35%) and falling from height in 10 patients that lead to bedridden till recovery or lead to paraplegic in these patients (25%).
The mean age was 42 (range from 14 to 75 years) were 32males (77%) and 10 females (23%) with male: female ratio (3:1) and all of them were treated surgically mostly by rotational flap which applied to 32 bed sores (14 sacral, 12 ischeal and 6 trochanteric) the other types of techniques were rhombic flap in 3 cases, V-Y flap in 4 cases, tensor fascia lata in 4 cases, 1ry closure in 9 cases and S.T.G in 3 cases. Surgical drainage was applied to all patients and removed after 5 to 7 days according to amount of blood discharged.
Broad spectrum antibiotics were administrated for 1 week and the patient discharged after removing of drainage if general condition was stable and the flap or graft wasn’t complicated.
A person that is bedridden or cannot move due to paralysis, or who has diabetes, vascular disease (circulation problems), incontinence, or mental disabilities, should be frequently checked for pressure ulcers.
The most frequent site was sacral in 25 cases followed by ischeal in 21 cases and finally trochanteric in 11cases.
Special attention should be paid to the areas over a bony prominence where pressure ulcers mainly form.
Risk assessment for developing pressure ulcers can be based on various risk assessment tools, and it can be used as a supplement to clinical assessment as: Norton, Waterlow and Braden scales.
The most common complications of pressure ulcers in our study were dehiscence that was due to infection in 4 cases, post-operative hypoalbumenemia in 2 cases and hematoma in 2cases.
Malignant transformation is very rare ( marjolin ulcer – secondry carcinoma in chronic wound ).
Prevention is better than cure” is best emphasized in the case of pressure ulcers. This condition is absolutely preventable with care, compassion, and dedication towards the care of patients. Prevention is directed towards taking care of the extrinsic and intrinsic factors.