Literature Review: The Pathophysiology, Prevention, and Evolving Management of Pressure Injuries (Bedsores)

Abstract

Background: Pressure injuries (PIs), commonly referred to as bedsores or decubitus ulcers, remain a major challenge in modern healthcare, associated with significant morbidity, prolonged hospitalization, and substantial economic burden. Their development reflects a complex interaction between mechanical forces and patient-specific vulnerability, necessitating a multidisciplinary approach to prevention and management. Objective: This review aims to synthesize current evidence on the pathophysiology, classification, and epidemiology of pressure injuries, and to translate this knowledge into an integrated framework for prevention, therapeutic management, and surgical reconstruction. Particular emphasis is placed on emerging regenerative strategies that may redefine future standards of care. Methods: A structured literature search was conducted using PubMed/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials for English-language publications up to March 2024. Primary studies, systematic reviews, meta-analyses, and clinical guidelines addressing the etiology, prevention, and management of pressure injuries in adult populations were included. The process involved synthesizing the findings narratively and organizing them into key thematic areas. Results: Clinically, this means that by the time a pressure injury is visible on the skin, the underlying damage from pressure and shear, including microvascular compromise, has often been progressing for some time, initiating deep tissue injury. The primary approach to pressure injuries is prevention relying on assessing risk systematically, providing evidence-based nursing care, optimizing nutrition, and using appropriate support surfaces. When prevention fails, therapeutic management is based on the wound stage, which includes debridement, specific and targeted wound dressings, and case by case, the use of adjunctive therapies like negative pressure wound therapy. Meanwhile, surgical reconstruction using well-vascularized flaps is reserved for advanced or refractory cases. Regenerative therapies like growth factors, bioengineered skin substitutes, and stem cell therapies are promising, and despite this promise, they remain preliminary and require further clinical studies. Conclusion: The management of pressure injuries is, by its nature, multidisciplinary, that requires the integration of nursing science, medical management, and reconstructive surgery. Although current preventive and therapeutic protocols remain fundamental, the next major advance lies in combining technological innovation with regenerative medicine. By focusing on the patient's biology, this approach can transform reactive treatment into proactive prevention and more manageable tissue repair.