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Pressure sores: Causes, treatment, and prevention


Informative medical information: 

Via MEDICAL NEWS TODAY, By Christian Nordqvist


Reviewed by University of Illinois-Chicago, School of Medicine



Pressure sores can affect people who spend a long time in one position, for example, because of paralysis, illness, old age, or frailty.

Also known as pressure ulcers and bedsores, pressure sores can happen when there is friction or unrelieved pressure on one part of the body.

People who cannot make even small movements are at risk of pressure sores.

The sores can affect any part of the body, but the bony areas around the elbows, knees, heels, coccyx, and ankles are more susceptible.

Bedsores are treatable, but, if treatment comes too late, they can lead to fatal complications.

The prevalence of pressure sores in intensive care units in the United States (U.S.) is estimated to range from 16.6 percent to 20.7 percent.


Contents of this article:

  1. Symptoms

  2. Causes and risk factors

  3. Diagnosis, treatment, and management

  4. Prevention

Fast facts on pressure soresHere are some key points about pressure sores. More detail and supporting information is in the main article.

  1. Pressure sores, pressure ulcers, or bedsores commonly affect people who cannot move easily.

  2. They are more likely to affect the bony parts of the body.

  3. The sores develop in stages. Identifying them in the early stage enables treatment and reduces the risk of complications.

  4. Moving patients frequently is key to preventing pressure sores.

Symptoms


[Pressure sores]

Pressure ulcers can affect patients who are unable to move because of paralysis, illness, or old age.

Bed-bound patients are most at risk of developing bedsores on the bony parts of their body, such as the ankles, heels, shoulders, coccyx or tailbone, elbows, and the back of the head.

Patients who use a wheelchair have a higher risk of developing pressure sores on their:

  1. buttocks and tailbone

  2. spine

  3. shoulder blades

  4. back of arms or legs

Pressure sores develop in four stages.

  1. The skin will look red and feel warm to the touch. It may be itchy.

  2. There may be a painful open sore or a blister, with discolored skin around it.

  3. A crater-like appearance develops, due to tissue damage below the skin’s surface.

  4. Severe damage to skin and tissue, possibly with infection. Muscles, bones, and tendons may be visible.

An infected sore takes longer to heal, and the infection can spread elsewhere in the body.

Causes and risk factors

Anyone who stays in one place for a long time and who cannot change position without help is at risk of developing pressure sores. The ulcers can develop and progress rapidly, and they can be difficult to heal.

Sustained pressure can cut off circulation to vulnerable parts of the body. Without an adequate supply of blood, body tissues can die.

According to Johns Hopkins Medicine, a sore can develop if blood supply is cut off for more than 2 to 3 hours.

Pressure ulcers are usually caused by:

Continuous pressure: if there is pressure on the skin on one side, and bone on the other, the skin and underlying tissue may not receive an adequate blood supply.

Friction: For some patients, especially those with thin, frail skin and poor circulation, turning and moving may damage the skin, raising the risk of bedsores.

Shear: If the skin moves one way while the underlying bone moves in the opposite direction, there is a risk of shearing. Cell walls and minute blood vessels may stretch and tear.

This can happen if a patient slides down a bed or a chair, or if the top half of the bed is raised too high.

Injured tissue can develop an infection. This can spread, leading to serious illness.

Risk factors


[Pressure sores immobility]

Pressure ulcers are more common among those who:

  1. are immobilized because of injury, illness, or sedation

  2. have long-term spinal cord injuries

Patients with long-term spinal cord injuries or neuropathic conditions, including diabetes, have reduced sensation.

They may not feel a bedsore developing, so they continue to lie on it, making it worse.

Patients who cannot move specific parts of their body unaided have a greater risk of developing pressure ulcers.

Factors that increase the risk include:

  1. Older age as skin gets thinner and more vulnerable with age

  2. Reduced pain perception, due, for example, to a spinal cord or other injury, as they may not notice the sore

  3. Poor blood circulation, due to diabetes, vascular diseases, smoking, and compression

  4. Poor diet, especially with a lack of protein, vitamin C, and zinc

  5. Reduced mental awareness, due to a disease, injury, or medication, can reduce the patient’s ability to take preventive action

  6. Incontinence of urine or feces can cause areas of permanently moist skin, increasing the risk of skin breakdown and damage

A low or high body mass index (BMI) increases the risk.

A person with a low body weight will have less padding around their bones, while those with obesity can develop sores in unusual places. Studies show that people with a BMI of 30 to 39.9 have a 1.5 times higher rate of developing pressure ulcers.

Diagnosis, treatment, and management


[Pressure sores relief]

A doctor will diagnose a pressure ulcer through a visual examination.

The physician will ask about recent medical history and they will check the size and shape of the sore, and if there is any oozing or weeping.

If the patient is not in residential care, a doctor may teach them how to carry out regular daily checks on themselves.

People should report any sign of a pressure sore to the doctor.

Treatment

Treating pressure ulcers is not easy.

An open wound is unlikely to heal rapidly. Even when healing does take place, it may be inconsistent, because of the damage to skin and other tissues.

Less severe pressure ulcers often heal within a few weeks with proper treatment, but serious wounds may need surgery.

The following steps should be taken:

  1. Remove the pressure from the sore by moving the patient or using foam pads or pillows to prop up parts of the body.

  2. Clean the wound: Minor wounds may be gently washed with water and a mild soap. Open sores need to be cleaned with a saline solution each time the dressing is changed.

  3. Control incontinence as far as possible.

  4. Remove dead tissue: A wound does not heal well if dead or infected tissue is present, so debridement is necessary.

  5. Apply dressings: These protect the wound and accelerate healing. Some dressings help prevent infection by dissolving dead tissue.

  6. Use oral antibiotics or antibiotic cream: These will can help treat an infection.

In the early stages, people may treat ulcers at home, but more severe ulcers will need dressing by a health care professional.

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