Management of a heel wound as part of the holistic care of patients at the end of their lives – a literature review and own professional experience

Introduction
The key objectives of palliative care include relief from suffering, improvement of the quality of life, dignified dying conditions and acceptance of impending death. The higher risk of developing pressure ulcers in palliative care patients is connected with the likelihood of the occurrence of undesirable symptoms, limited self-care and the destruction of the skin and subcutaneous tissues in each area exposed to pressure. In patients over 65 years of age, pressure ulcers on the heel, coexisting with limb ischemia, may increase the risk of premature death.

Aim of the study
The objective of the study was to identify the directions of intervention performed in the management of pressure ulcers on the heel in accordance with the guidelines of the Polish Wound Management Association (Polskie Towarzystwo Leczenia Ran (PTLR), the Europe Pressure Ulcer Advisory Panel (EPUAP), the National Pressure Injury Advisory Panel (NPIAP), as well as own experience.

Material and methods
Analysis of literature based on the guidelines of PTLR, EPUAP and NPIAP.

Conclusions
Holistic and interdisciplinary care for the patients at the end of their lives is an integral part of palliative care. Secondary prevention and wound management aiming at minimising negative symptoms play an important role in the therapeutic process. Wound management taking into account clinical practice gives wide opportunities in the scope of methods and measures to minimise exudate caused by local infection.