UDC. 616.314.17-008.1-084:615.015

Abstract. The purpose of the study was to optimize clinical classification, secondary prevention and treatment of complicated stage III and IV of pressure ulcers caused and prolonged or persistent loss of motor activity, arise as a result of injuries or diseases of the spinal cord and brain, severe somatic pathology, accompanied by impaired innervation and tissue trophism which are based on clinical observation and complex strategy in a palliative care unit or department. It is worth emphasizing that in addition to specific preventive measures, it is necessary
to treat any concomitant diseases and syndromes that contribute to the formation of bedsores of various localization, especially in diabetes, occlusive diseases of the arteries, etc., to ensure adequate analgesia and correction of the water-electrolyte balance. In our study, the total sample consisted of 412 patients aged 40-93 years: 174 men and 238 women, who were treated inpatient for 10 years in the palliative care department of the Lviv Regional Medical Association "Clinical Hospital of Planned Treatment, Rehabilitation and Palliative Care" , separate unit "4 hospital" and medical center "Salutas", Lviv, Ukraine. In their work, they used plans for the
care and complex treatment of bedsores according to the TIME and DOMINATE strategies, which included adequate nutritional support, orthopedic decompression of problem areas, remediation of bedsores (including surgical treatment if necessary) with antiseptics. Adequate care and treatment of patients with chronic wounds and,
in particular, pressure ulcers is possible only the DOMINATE strategy, in the presence of colliquative (wet, moist) necrosis or demarcated (limited) dry of areas of necrosis. It is necessary to take into account the peculiarities of the wound process in the formation of purule nt pressure ulcers, the composition of the microflora, which affects the course of healing and requires not only antibiotic therapy but also the use of topical antiseptics, providing appropriate care, monitoring the dynamics of the bedsores wound process and correcting local venous and/or lymphatic stasis, background and comorbid pathology.
Keywords. Complicated stage III and stage IV decubitus ulcers, soft tissue necrosis, purulent-necrotic complication, putrefactive phlegmon, clinical strategy, secondary prevention, complex surgical treatment.