2019版《压疮/压力性损伤的预防和治疗:临床实践指南》解读

从压力性损伤的定义和分类、压力性损伤的特殊人群、压力性损伤的预防、压力性损伤预防和治疗的共同措施、压力性损伤的治疗方面对2019版《压疮/压力性损伤的预防和治疗:临床实践指南》的更新进行解读,旨在让临床护理人员了解国际压力性损伤的新进展,从而提高压力性损伤预防和治疗的护理质量,减轻患者的痛苦。     

The effectiveness of topical negative pressure in the treatment of pressure ulcers: a literature review

The objective of the study was to gain insight into the effectiveness of vacuum-assisted closure (VAC) therapy or, more particularly, topical negative pressure (TNP) in the treatment of pressure ulcers. We carried out a systematic search in Medline, Embase and Cinahl for Randomized Clinical Trials (RCTs) involving topical negative pressure in pressure ulcers over the period 1992–2007. Five RCTs were included. Two studies dealt exclusively with pressure ulcers. No significant differences in wound healing were found in these studies. Three other studies (mixed etiology of wounds) did show significant differences in wound healing, in the decrease of wound treatment time, and in the decrease in number of bacteria. The quality of these studies, both in terms of methodology and otherwise, did not always match with the scientific standard. Moreover, these studies lacked subgroup analyses. The analyzed studies described positive effects of TNP, although both the control treatment and the end points varied in these studies. On the basis of the systematic assessment of these five RCTs, the conclusion is that TNP has not proven to be more effective than various control interventions. The differences between and within the studies in terms of control interventions, the differences in randomization and a number of weaknesses in the analyses do not allow a good comparison. The main recommendations for follow-up studies include: randomization of patients rather than of wounds, a homogeneous patient population, the use of a single well-defined and procedurally documented control intervention, and prior calculation of the random sample size.     

粘贴式负压冲吸器在治疗结直肠术后切口感染中的应用研究

目的 探讨应用粘贴式负压冲吸器治疗结直肠术后切口感染的效果.方法 将2010年1月-2011年11月南京军区福州总医院普通外科收治的48例结直肠手术后出现切口感染的患者,按照抽签随机分组的方法,随机分为实验组和对照组,实验组24例,采用粘贴式负压冲吸器治疗;对照组24例,采用传统处理方法治疗.对比2种方法的人均伤口处理时间、换药次数和换药总费用.结果 实验组自开始处理感染切口至二期缝合所需要的人均伤口处理时间(6.12±1.19)d短于对照组(8.54 ±2.98)d,差异有统计学意义(P＜0.05),人均换药次数[(1.44±0.51)次]明显少于对照组[(9.42±2.92)次],差异有统计学意义(P＜0.01),人均换药总费用也少于对照组,差异有统计学意义(P＜0.05).结论 应用粘贴式负压冲吸器治疗结直肠术后切口感染,能缩短伤口处理时间,减少了换药次数和换药总费用,具有较高的临床应用价值.     

手术室患者压疮临床特点的回顾性分析

目的分析手术室压疮的临床特点,为指导临床改进术中压疮预防实践提供参考。方法采用回顾性描述研究,以某三甲医院手术室2013年发生压疮的115例手术患者为研究对象,对术中压疮的发生率、发生部位和分期,患者的年龄与科室、手术时间和手术体位等临床特点进行回顾性分析。结果手术患者压疮发生率为0.23%,以I期压疮为主。术中压疮的高发科室是骨科、神经外科和胸外科,高发体位为俯卧位,好发部位为颜面部、髂前上棘、胸部和双下肢骨隆突处。结论护理人员应根据术中压疮的临床特点,选择应用具有针对性的压疮预防措施。     

Effectiveness and safety of olive oil preparation for topical use in pressure ulcer prevention: Multicentre,controlled, randomised,and double‐blinded clinical trial

This non‐inferiority, multicentre, randomised, controlled, and double‐blinded clinical trial compared the therapeutic effectiveness of the topical application of an olive oil solution with that of a hyperoxygenated fatty acid compound for the prevention of pressure ulcers in at‐risk nursing home residents. The study population comprised 571 residents of 23 nursing homes with pressure ulcer risk, randomly assigned to a hyperoxygenated fatty acid group (n = 288) or olive oil solution group (n = 283). Both solutions were applied on at‐risk skin areas every 12 hours for 30 days or until pressure ulcer onset. The main outcome variable was the pressure ulcer incidence. The absolute risk difference was estimated (with 95% CI) using Kaplan‐Meier survival and Cox regression curves. The groups did not significantly differ in any study variable at baseline. The pressure ulcer incidence was 4.18% in the olive oil group vs 6.57% in the control group, with an incidence difference of −2.39% (95% CI = −6.40 to 1.56%), which is within the pre‐established non‐inferiority margin of ±7%, thus supporting the study hypothesis. We present the first evidence of the effectiveness and safety of the topical application of olive oil to prevent pressure ulcers in the institutionalised elderly.     

Sildenafil in the treatment of pressure ulcer: a randomised clinical trial

Pressure ulcer (PrU)‐related hospitalisation and mortality are critical issues in medical and surgical patients. Although animal studies have suggested the beneficial effects of sildenafil on wound healing, related clinical data are lacking. This is the first clinical study that has evaluated the effects of topical sildenafil on PrU healing in human subjects. Enrolled patients were randomly allocated to receive topical sildenafil (10%) ointment or placebo daily. Wound healing was assessed visually and photographically by the change in wound score according to two‐digit Stirling scale. Decreases in grades of the PrUs were significantly higher in sildenafil group compared with placebo group (P < 0·001). In addition, surface areas of ulcers in sildenafil group were significantly reduced compared to the control group at day 14 of intervention (P = 0·007). It appears that these effects may be mediated by improvement of microvascular reperfusion in the skin and soft tissue. Further study to emphasise the role of topical sildenafil in the prevention or treatment of PrUs in hospitalised patients is required.     

Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries

In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.     

A non‐randomised,controlled clinical trial of an innovative device for negative pressure wound therapy of pressure ulcers in traumatic paraplegia patients

The conventional methods of treatment of pressure ulcers (PUs) by serial debridement and daily dressings require prolonged hospitalisation, associated with considerable morbidity. There is, however, recent evidence to suggest that negative pressure wound therapy (NPWT) accelerates healing. The commercial devices for NPWT are costly, cumbersome, and electricity dependent. We compared PU wound healing in traumatic paraplegia patients by conventional dressing and by an innovative negative pressure device (NPD). In this prospective, non‐randomised trial, 48 traumatic paraplegia patients with PUs of stages 3 and 4 were recruited. Patients were divided into two groups: group A (n = 24) received NPWT with our NPD, and group B (n = 24) received conventional methods of dressing. All patients were followed up for 9 weeks. At week 9, all patients on NPD showed a statistically significant improvement in PU healing in terms of slough clearance, granulation tissue formation, wound discharge and culture. A significant reduction in wound size and ulcer depth was observed in NPD as compared with conventional methods at all follow‐up time points (P = 0·0001). NPWT by the innovative device heals PUs at a significantly higher rate than conventional treatment. The device is safe, easy to apply and cost‐effective.     

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.     

自制简易负压吸引装置在创面修复术前的应用

目的:探讨自制简易负压吸引装置在创面修复术前期准备中的治疗作用。方法:对27例有皮肤软组织缺损的患者采用自制的简易负压吸引装置治疗,并在每次更换负压装置时进行清创。经过7～30日,平均15.6日的治疗后,在创面上行二期游离植皮或皮瓣转移修复术。结果:27例患者经过治疗后创面清洁,面积较前缩小,肉芽生长新鲜,游离植皮或皮瓣转移修复均一次性获得成功。结论:自制简易负压吸引结合间断清创能够减少创面污染,促进肉芽组织生长,促进创面的愈合,为二期手术创造条件,缩短术前准备时间,且减轻医务人员换药工作量,减轻患者痛苦。     

IPARZINE‐SKR study: randomized,double‐blind clinical trial of a new topical product versus placebo to prevent pressure ulcers

This study compared the efficacy of a new topical agent (IPARZINE‐4A‐SKR) on preventing category I pressure ulcers (PUs) over a 2‐week period, compared with a placebo. A double‐blind, randomised, multi‐centre, placebo‐controlled clinical trial in two parallel groups was conducted. The primary objective was to compare PU incidence between groups. Hospital and socio‐sanitary centre patients (n = 194) at risk of developing a PU (Braden scale) were randomised into two groups. The intervention group included 99 patients, and the placebo group comprised 95 patients. Patients were comparable in terms of age, sex and PU risk. In both groups, patients had a high risk of developing PUs. The product was applied on the sacrum, trochanters and heels. Six PUs (incidence = 6·1%) were detected in the intervention group versus seven (incidence = 7·4%) in the placebo group. Differences were not statistically significant (z = 0·08; P = 0·94), relative risk = 0·82 (95% confidence interval = 0·29–2·36). The main limitation of the study was the sample size and, therefore, the main difficulty encountered was in determining whether the product is ineffective or simply has not been used with sufficient patients. In conclusion, it is not possible to confirm that there are any differences between the studied and the placebo treatments in the prevention of PUs. The results obtained were similar to those obtained in studies of PU prevention using products based on topical fatty acids.     

ChitoHeal gel use on the nasal site for prevention of N95 masks caused pressure injuries: A randomised clinical trial

Prolonged use of personal protective equipment can cause pressure injuries on the skin. The current study was conducted with the aim of investigating the effect of ChitoHeal gel on the nasal site on the prevention of N 95 masks that caused pressure injuries in nurses working in intensive care units. This is a randomised controlled clinical trial that was conducted in 2022. The study sample consisted of 92 nurses working in the intensive care units. A randomised block method was used to allocate the nurses to two equal groups of intervention and control. However, in the intervention group, ChitoHeal gel was applied on nurses' nose bridge. To perform this, the researcher referred to the department during the morning and evening shifts and applied the gel on nurses' nose bridge at the beginning of each shift. Then, the N95 mask was installed on the face by the nurse. Before and at the end of each work shift, the skin in both groups was assessed for any signs of pressure injuries. No significant differences were observed between the two intervention and control groups in terms of demographic variables. The frequency distribution of mask-caused pressure injuries on nurses' nose bridge in the two groups was analysed using the Chi-square test (Fisher's exact test). The results showed that after the intervention, it was 0 in the intervention group. However, 4 nurses (8.6%) in the control group developed pressure injuries, and this difference between the two groups was statistically significant (P > .05). The result of the current study showed that the use of ChitoHeal gel is effective in preventing N95 mask-related pressure injuries. Considering the cheapness and rational global availability of this gel, it seems that its use is an effective strategy in order to prevent N95 mask-related pressure injuries. Given the lack of studies in this regard, similar studies are strongly recommended to be conducted.     

Analysis of the clinical features and risk factors of device-related pressure injuries in the operating room

To describe the clinical features and risk factors of device-related pressure injuries (DRPIs) in the operating room. The clinical features of the DRPIs in patients undergoing elective surgery in a tertiary hospital in 2020 were investigated through prospective data collection. A DRPI-related questionnaire was designed for the patients, and those who did not experience any DRPI were selected according to a ratio of 1:2. Logistic regression analysis was performed in terms of the independent risk factors of operating-room DRPIs. A P-value of <.05 indicated a statistically significant difference. The incidence of operating-room DRPIs was 0.56%, and the proportion of stage I injuries was 73.53%. The injury-related devices included vital monitoring devices (31.62%), auxiliary therapy devices (27.94%), therapy devices (19.12%), and dressings (3.67%). Non-bone protuberances, such as the upper arms and thighs, were common injury sites. The patients' body mass index, mean arterial pressure, and instrument action time were independent risk factors for the operating-room DRPIs. To reduce the incidence of operating-room DRPIs, it is of great clinical significance to focus on the characteristics of the surgical patients and the types of surgery-related devices used and to take personalised preventive measures based on the relevant risk factors.     

Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trial

The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index >or=0.80] ranged from 5 to 25 cm(2) with a duration >or=3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with >or=40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71.3 +/- 13.5 years, body mass index was >or=30 kg/m(2) in 39.3% and 15.4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11.2 +/- 7.4 cm(2). At the last evaluation, mean difference between the groups for %RR was 33.6 +/- 15.0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8.6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0.0059 for superiority test). The median of the wound area reduction was 61.1% and 7.7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54.4% versus 12.9% in intent-to-treat analysis (p = 0.0286). Median AR was 4.2 cm(2) in the NOSF group and 1.0 cm(2) with ORC (P = 0.01). Median HR was -0.056 and -0.015 cm(2)/day in NOSF and ORC groups, respectively (P = 0.029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2.4 (95% CI: 1.1-5.3; P = 0.026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis.     

负压封闭引流术在烧伤整形中的临床应用价值

目的:探讨分析负压封闭引流术在烧伤整形专业中的临床应用价值.方法:选择2011年4月～2012年6月于我院烧伤整形科接受创面修复治疗的患者94例,给予负压封闭引流术治疗,然后对患者的治疗结果进行分析.结果:94例患者手术均顺利完成,无死亡病例出现；患者创面的愈合时间为8～35天,平均(15.2±4.1)天；抗生素的应用率13.8％；院内交叉感染率5.3％；住院时间为25～46天,平均(32.5±5.3)天:创面肉芽组织生长良好,修复后皮肤表面平整.结论:负压封闭引流术在烧伤整形专业的创面治疗中效果显著,能够加快创面愈合、缩短住院时间从而较少医疗费用、减轻患者疼痛、改善预后,具有极高的临床推广价值.     

Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial)

Introduction

Early excision and grafting (E&G) of burn wounds has been reported to decrease hospital stay, hospital costs and septic complications, and some purport reduced mortality while decreasing hospital costs.In today's practice, all burn wounds unlikely to achieve spontaneous closure within 3 weeks are excised and grafted. Early studies did not demonstrate dramatic differences in cosmetic or functional results. This is particularly true with burns of the face, hands and feet. In this study, early excision and skin grafting was compared with delayed skin grafting in deep hand burns.

Materials and methods

From September 2006 to February 2008, 50 patients with hand burns and average burn size less than 30% total body surface area (TBSA) deep second- and third-degree were randomly divided into early E&G group (group I) and delayed grafting group (group II).Gradual and careful limb and digit range of motion was started on about 10th-14th postoperative day. We used a questionnaire based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate final functional outcome. Further, hypertrophic scar formation, contracture and deformities were followed and managed accordingly.

Results

The most common site of involvement was the metacarpophalangeal (MCP) joint with frequency of 39% and 40% in groups I and II, respectively. There were no statistically significant differences between both groups regarding deformity severity, scar formation, sensation, major activities and overall satisfaction.

Discussion

In treating burns of the hand, the primary goal should always be to restore the functionality of the hand. Although early surgery shortens the healing time and lessens the hospital stay, our results did not show any significant difference between these two methods regarding the function, scar formation, daily activity limitation and overall satisfaction.     

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients,when compared to usual care turning and positioning devices,for the prevention of hospital-acquired pressure injuries. A randomised controlled trial

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.     

Esmolol cardioplegia in unstable coronary revascularisation patients. A randomised clinical trial

BACKGROUND: Esmolol has been studied and applied to control hypertension and tachycardia during open heart surgery. Esmolol has been used on a minor scale as a single cardioplegic agent. Little information is available on esmolol as a component of blood cardioplegia. In this prospective, randomised, double-blind clinical study we investigated whether esmolol improves cardioprotection in patients scheduled for an urgent coronary operation. METHODS: Forty patients with unstable angina were operated using cold blood cardioplegia as the basic cardioprotective method. Cardioplegia was infused intermittently, and esmolol was given into the cardioplegia line (15 mg/min) during cold infusions. Patients with ongoing myocardial infarction were excluded. RESULTS: The arrest time during the cardioplegic induction or the rate of spontaneous resumption of the heart rhythm did not differ significantly between the groups. The serial measurements of plasma creatine kinase MB-fraction activity (P=0.27), serum creatine kinase MB-fraction mass assay (P=0.16), troponin I (P=0.41) and myoglobin (P=0.14) similarly did not differ between the groups, nor did myocardial lactate extraction (P= 0.12). CONCLUSION: Esmolol addition to blood cardioplegia did not increase the efficacy of cardioprotection in the present study setting in unstable patients during urgent coronary revascularisation.     

Efficacy and safety of percutaneous nephrolithotomy combined with negative pressure suction in the treatment of renal calculi: a systematic review and meta-analysis

BackgroundWith advances in medicine, there have been more and more ways to treat renal calculi in recent years. Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment. The purpose of this paper is to study the efficacy and safety of PCNL combined with negative pressure suction in the treatment of renal calculi by meta-analysis.MethodsThe PubMed, EMBASE, Cochrane Library, Chinese Journal Full-Text Database, VIP, Wanfang Science and Technology Journal Full-Text Database, and Chinese Biomedical Literature Search databases were searched for articles related to the efficacy and safety of PCNL combined with negative pressure suction in the treatment of renal calculi from the establishment of the databases to October 2021. Endnote X9 software was first used to check and eliminate the articles, and the quality of the included articles were evaluated according to the risk of bias tool of Cochrane Collaboration. Stata 15.1 software was used to record the data. A meta-analysis was performed on the stone clearance rate, operation time, postoperative complications, postoperative fever, septic shock, intrapelvic pressure, and blood loss of PCNL combined with negative pressure suction in the treatment of renal calculi. The reliability of the results was assessed by a sensitivity analysis. Egger’s linear test was used to test the publication bias of the articles.ResultsA total of 10 articles were included in the meta-analysis, and the total sample size of the study was 820. The meta-analysis showed that when PCNL combined with negative pressure suction was used to treat renal calculi, the stone clearance rate and the occurrence of septic shock of the test group did not differ significantly from that of the control group; the incidence rate of postoperative complications、the operation time, the intraoperative bleeding and the postoperative fever of the test group was significantly better than that of the control group.DiscussionCompared to the group without negative pressure, PCNL reduces the operation time, postoperative complications, postoperative fever, septic shock, and intraoperative blood loss without increasing the risk of septic shock.     

Skin hydration measurement and the prediction of the early development of pressure ulcers among at risk adults: A systematic review

This systematic review aimed to examine skin hydration and determine if this biophysical parameter can predict pressure ulcer development in at risk adults. A literature search was conducted in March 2022, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 1727 records were returned, with 9 studies satisfying the inclusion criteria. Data were extracted using a pre-designed extraction tool and a narrative synthesis of the data was undertaken. The methodological quality of the included articles was assessed using the evidence-based librarianship checklist. Included studies were published between 1997 and 2021, with most using a prospective cohort design (88.9%, n = 8). The mean sample size was 74 participants (SD = 38.6; median 71). All studies measured skin hydration objectively, with 55.6% (n = 5) using the Corneometer® CM825 and 33.3% (n = 3) of studies reported a statistically significant association between skin hydration and pressure ulcer development. The mean evidence-based librarianship percentage was 66.6% (SD: 20.7%), however, only 33.3% (n = 3) of studies scored ≥75%, indicating validity. The quality of included studies, methodology variation, and reported results has reduced the homogeneity of outcomes. This review highlights the requirement for future research evidence to ascertain the role of skin hydration in pressure ulcer development.