A escarre is a cutaneous lesion of ischemic origin related to a compression of fabrics soft between a hard plan and osseous projections (definition established in 1989 by the National Presses Ulcer Advisory Panel ). The escarre is also described as a Plaie of inside apart from conical form (part of the lesions is not visible), at major base, which differentiates it from cutaneous abrasions. Its origin is multifactorielle, however the role of the allied pressure to the loss of mobility is prevalent.

The escarre being particularly difficult to reabsorb once engaged, the prevention on behalf of medical staff is determining in this process which affects approximately 5% of in-patients. A few hours sufficient with its appearance, the supporting factors must be reduced and regularly controlled.

A conference of consensus held in France described in 2001 three types of escarres according to the situation:

• the “accidental” escarre related to a temporary disorder of mobility and/or conscience;
• the “neurological” escarre, consequence of a chronic, driving and/or sensitive pathology: topography is especially crowned or trochantérienne, the surgical indication is frequent according to the characteristics (surface and depth), the age and associated pathologies; the risk of repetition is raised, from where the need for a strategy of prevention and education;
• plurifactorielle” of the subject confined with the bed and/or the armchair, polypathologic escarre the “, in reanimation, geriatrics or palliative care, where prevail the intrinsic factors: the localizations can be multiple, the vital prognosis can be concerned, the surgical indication is rare, the treatment is especially medical.

The escarre can take several forms of different gravity: a simple redness persisting more than one day, an induration of the Skin, a more or less deep wound being able in the serious cases to reach the Muscle S or the subjacent Os.

A escarre is thus a deep wound (and not a Ulcération), caused by a suppression of the blood irrigation of fabrics, involving the Nécrose (or tissue death). The Cicatrisation is not spontaneous.

One can note 5 stages of evolutions: 1- Redness with edema 2- Phlyctene and desepidermation 3- Ulcerate and necroses 4- Extension of the ulcer 5- Multipication of the escarres at various stages

The escarres are current among lengthily confined to bed patients (sick at the end of the lifetime, in the Coma, paraplegic, in reanimation, etc)

At the people at the risk, the appearance of escarres is supported by the states of Dénutrition and Déshydratation, like by hyperthermia (Fièvre) and more generally not the states of hypovigilance.

To avoid the escarres, a set of measures must be taken at the person at the risk:

* to use adapted mattresses and cushions;

* to frequently change position (at least 2 to 3 a.m.);

* to maintain the hygiene of the skin and to avoid the maceration;

* in the event of incontinence, to change protections regularly;

* to observe or remark daily the cutaneous state;

* to make sure that the food sufficient and is adapted;

* to drink or make drink regularly and in sufficient quantity.

* to make sure that cloths of the bed are well tended, without crumbs, and that the pipes of perfusions are not wedged under the patient

The treatment is difficult and requires of the personnel trained with the assumption of responsibility of the escarres. It requires if possible a setting in local discharge and in all the cases of the attentive local care, by preventing that the causes of the escarre of reproduce. The goal is to obtain D-épidermisation of the escarre by leaving the wound in moist environment and clean (not sterile). The care is daily or triweekly:

*Nettoyage of ulceration to water and soap

surgical *Ablation of fabrics necrosed and fibrins of cicatrization

*Pansement wet (plates hydrocellulaires for example) or bandage fatty (standard fatty tulle), inter alia. The bandage is selected according to the characteristics of the wound (exsudative, cavitary, infected…) and the stage of cicatrization.