When are the seeds of postoperative pressure sores sown?

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Abstract
Pressure sores are often thought to be slothful chronic wounds forming slowly because of poor nursing.1 In fact, they are acute injuries which develop rapidly when compression of tissues causes ischaemia and necrosis during serious illness and trauma, including surgery.2 Many of the situations predisposing to pressure sores are well known (though often less well acted on), but those that arise before, during, and after surgery deserve more attention than they have received. In the United States it has been suggested that up to a quarter of pressure sores that develop in hospital originate in the operating theatre.3 Protracted squeezing of tissues between weight bearing surfaces and bony prominences cannot account for the whole pathogenesis of bedsores. An endogenous factor must be invoked that is common to the diverse conditions predisposing to pressure injury—namely, old age, malnutrition, alcohol abuse, diabetes, advanced cancer, terminal illness, sepsis, and vascular and neurological disease. These are all conditions in which multiple organs tend to fail because of failure of the microcirculation. Accordingly, pressure sores should be viewed as the result of yet another organ …