Pressure Sores

WHAT YOU SHOULD KNOW

Pressure sores—also known as bedsores, decubitus ulcers, or skin ulcers—are patches of tissue damage over a bony prominence such as the shoulder blades, elbows, lower back, hips, knees, ankles, and heels. People who are paralyzed, bedridden, or confined to a wheelchair are most likely to suffer from pressure sores. The risk is greatest for those with a decreased sense of pain, such as victims of nerve damage—from an injury or stroke for example—and for those suffering from malnutrition. Left untreated, a developing pressure sore goes through several stages:

• Stage 1: Unbroken skin is red, but the sore has not actually formed.
• Stage 2: The skin is red and swollen, often with blisters; the topmost skin layers begin to die.
• Stage 3: The sore has broken through the surface, exposing deeper layers of skin.
• Stage 4: The sore extends deeply through the skin and fat and into the muscle.
• Stage 5: The muscle is destroyed.
• Stage 6: The bone is exposed, and often damaged and infected.

Causes

The skin has a rich blood supply that delivers oxygen to all of its layers. A sore develops when constant pressure on the skin cuts off this life-giving oxygen supply for extended periods of time. Typically, the problem arises when the skin has been under pressure from a bed, wheelchair, cast, splint, or other hard object for several hours.

Ill-fitting clothing, shoes that rub against the skin, and wrinkled bedding can also contribute to pressure sores.

Signs/Symptoms

The first warning of an incipient sore is an area of skin that remains red, inflamed, and sore even when pressure on it is released. In most people, the sore causes pain and itching, but in those whose sensitivity is dulled, even severe, deep sores, may be painless.

Care

The earlier a pressure sore is detected and relieved, the better are the chances that the sore will heal on its own without any lasting effects. In the early stages (before the sore reaches underlying fat and muscle), the sore can usually heal by itself once the pressure is relieved. Protein and calorie supplements will promote the healing.

However, if the sore has reached Stage 4 or more, the healing process will need help. Dead tissue must be removed in a procedure called debridement. For more advanced sores, this may require surgery, and a skin graft may be necessary to repair the damage. Antibiotics will be needed if the sore becomes infected.

Risks

If the sore is left untreated, infection can take hold and, spreading into the bloodstream, pose life-threatening consequences. The more advanced the sore becomes, the more difficult the cure.

WHAT YOU SHOULD KNOW

• Prevention is the best solution for pressure sores. Any sign of redness on the skin on any part of the body is a warning that a bed sore is forming and immediate preventive action is needed.
• Protect bony projections with soft materials, such as cotton, fluffy wool, or sheepskin.
• Put pillows between the knees and under the shoulders.
• Use pads on beds, wheelchairs, and regular chairs to reduce pressure.
• Consider getting a special mattress, such as an air-suspension, water, or foam egg-crate mattress. It will allow you to shift pressure more easily and provide relief.
• Turn a person who can not turn himself twice an hour, or at the very least, once every two hours.
• Keep the skin clean and dry.
• Protect broken skin with gauze bandages coated with either Teflon or petroleum jelly to keep them from sticking to the wound.
• Wash the sore frequently and gently with soap and warm water. Do not wash too vigorously, as that will hinder healing.
• Apply antibiotic cream as prescribed by the doctor after the site is washed and dried. (Some antibiotics may be taken orally.)
• If a sore is infected or oozing, wash the area with other agents in addition to soap and water, such as special disinfectants which can remove dead and infected matter.

Call Your Doctor If...

• The sore shows signs of infection such as pus or drainage.
• The sore reaches tissues below the skin.

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