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Pressure ulcers

Pressure ulcers can lead to long- term rehospitalization and account for a disproportionate number of rehospitalization days. Rehospitalisation, and more so the prolonged hospital-stay seen in patients with pressure ulcers, easily leads to the need for additional rehabilitation therapy to regain strength, endurance and function lost while rehospitalised. Rehospitalisation can be disruptive, undermine rehabilitation gains, and diminish an individual’s ability to live actively and independently.

What is a pressure ulcer?

A pressure ulcer is localised injury to the skin and/or underlying tissue as a result of inappropriate pressure – intense or prolonged pressure or pressure in combination with shear. It usually occurs over bony prominences. Oxygen and nutrients are carried around to all cells in the body by the blood. If any cells are deprived of this supply for too long, they die – this is called ischaemia. It is thought that a too inappropriate pressure collapses or even crushes the vessels and impede the blood supply to the cells for long enough to also kill a certain amount of soft-tissue cells in the area. This combination leads to tissue death / necrosis that cannot be rapidly contained and repaired due to the impairment of the paths that are necessary in order to carry the supplies required for restructure (the blood vessels) as well as the paths of the repair personnel (the lymph vessels). The presence of dead tissue for a too long period of time in the deeper layers of the skin and/or the underlying soft-tissue, gives rise to an inflammatory process that can spread rapidly to the surrounding tissue causing further tissue death. This inflammation is seen on the skin surface as “inexplicable” redness. At this stage it is of paramount importance to react quickly and make sure that any pressure is taken off that body area immediately and until there are no more traces of redness (usually days) as this will indicate that restructuring and healing has taken place. If the developing injury is not detected and off-loaded of any pressure at this early stage, it will break through the skin and an ulcer will have formed. Once this happens, the area will immediately be colonised by the microbes that are present on the surrounding skin and in the immediate environment. To prevent an infection and to support healing, it is important to support and maintain a balanced microbiome in the wound and surrounding area.

Pressure ulcers tend to develop quickly and are prone to infection. As the vessels in the area are involved, pressure ulcers have a high prevalence of septicaemia / blood infection or blood poisoning, i.e. bacteria and other microbes passing into the blood stream and being carried around in the entire body, including to the vital organs. As pressure ulcers often develop over bony structures, they are also often associated with osteomyelitis, i.e. infection of the bone. Also, skin infection / cellulitis is closely associated with pressure ulcers. Septicemia, osteomyelitis and cellulitis are common complications of pressure ulcers and high risk factors of developing sepsis.

Current treatment of pressure ulcers

The National Institute for Clinical Excellence (NICE) guidelines and the latest Cochrane reviews on dressings, topical treatments and NPWT (a pump using vacuum to remove wound exudate) recommend the following treatment for pressure ulcers:

1) Systemic antibiotics should not be used to treat a pressure ulcer, according to NICE.

2) Topical antiseptics or antimicrobials should not, according to NICE, routinely be used to treat a pressure ulcer. The Cochrane review found no data to indicate that any dressing type or antimicrobial were better than saline-soaked gauze. The Cochrane review even found itself unable to suggest what comparators to include in an RCT study.

3) NPWT (the pump) is not recommended by NICE for routine use on pressure ulcers, except to control the exudate. The Cochrane review could find no data to support its use in pressure ulcers.

4) NICE recommends considering moist wound care (covering the wound with an occlusive dressing). However, data indicate that the moist environment will exacerbate an infection ( The Cochrane review, which is more recent, did indeed find no data to support this approach.

In conclusion, there are no data to support the use of any of the existing approaches for the treatment of pressure ulcers. This is in line with the recent study by Guest et al. (2018) that only 14% of infected pressure ulcers heal within the first 12 months. The use of antibiotics and antiseptics for other wound types have, in a similar manner, not demonstrated any clinical effects, which led both the FDA and NICE in 2016 to conclude that there is no effective treatment for infected wounds.

Amicapsil consistently treats pressure ulcers and the treatment is easy and inexpensive if initiated before the wound is more than 2 months old. Amicapsil is effective in immunocompromised individuals as well.


 “It is amazing stuff that Amicapsil.” VH (patient)


"It's no exaggeration to say that Amicapsil is a miracle cure. My paraplegic husband had been bed bound for NINE WEEKS due to a deep pressure sore on his buttock, which, using various gels, packing, dressings and other standard wound care techniques, had not improved at all. When we discovered Amicapsil and insisted on trying it the results were astonishing. My husband's pressure sore was treated with Amicapsil for just 3 days and by the 6th day it had reduced in size and depth by 90%. Finally we had found the cure for this debilitating and seemingly untreatable wound in such a simple and painless treatment. We can't recommend it enough, THANK YOU AMICAPSIL!" BB

Individuals with restrictions to movement are most at risk of pressure injuries. Therefore, pressure injuries are a serious complication of spinal cord injury (SCI) and can seriously impact the person’s quality of life. They may disrupt rehabilitation, prevent the person from attending work or school, and interfere with community reintegration.

When a pressure ulcer is severe and not treated aggressively it can lead to further disability, e.g. reduced mobility, dependence, surgical intervention, amputation, fatal infection.

It has been estimated that pressure ulcers can account for approximately one-fourth of the cost of care for individuals with SCI.