Pressure sore--the problem.

The problem is that when the surface of the body is denervated, it is liable to break down from a number of widely different mechanical stresses. The obvious common factor of denervation or loss of sensation has allowed many workers to assume that loss of nerves is the most significant element in the aetiology of these pressure sores. Hence, the term 'trophic' ulcer, which suggests that some trophic, or nourishing, element is missing from tissues which are not supported by intact nerves. The nature of this trophic factor is not understood and therefore its influence is difficult to measure and still more difficult to control. We have found that a more fruitful approach to the problem is to concentrate upon the biology and the mechanics of the breakdown of normal surface tissues, and then see if it is very different from the biology and mechanics of the breakdown of denervated tissues.