Pressure Sores, Ulcers

Pressure sores are also known as decubitus ulcers or bedsores. They are lesions which are primarily caused by constant pressure on soft tissues which cover bony parts of the body restricting blood flow to the contact areas. Generally, the most likely areas to be affected are the hips, elbows, knees, ankles or the back of the head.

The main factors causing decubitis ulcers – other than unrelieved pressure – are friction and shearing forces affecting the contact area when moving the person, and humidity caused by sweating or incontinence. The patient’s inability to move about and adjust position when sitting or reclining can quickly lead to the development of pressure sores unless prevention measures are taken.

The development of bedsores in frail and elderly people can sometimes be fatal, despite medical intervention, so care and prevention is critical for inactive and immobile people. Current best practise for early prevention of decubitis ulcers is the use of pressure relieving surfaces such as air mattresses, medical sheepskins or specialised cushions for seating. This is a  primary consideration where an individual is unable to readily change position by their own efforts. A valuable aid to pressure wound prevention as an aid to pressure relief is the use of a genuine medical grade sheepskin.

Common sense suggests prevention is better than cure, which applies particularly to pressure sores, being both painful and slow to heal, and most of which are definitely preventable if good clinical practice is followed.

It is most important those who are at risk are identified and to intervene early with strategies for prevention, in the bed, wheelchair, chair, in the bath or on the commode.

The main treatment of decubitis ulcers is to remove or reduce the pressure by turning the patient regularly (at least every two hours is considered effective), together with other medical interventions. Care procedures are typically defined as low, medium, high with different and increasingly complex procedures necessary to be followed by nursing staff.

An inadequate blood supply and resulting reperfusion injury when blood re-enters tissue can be the cause of pressure ulcers, often experienced by healthy individuals seated in the same position for extended periods of time: the resulting dull ache is indicative of reduced blood flow to affected areas. This may lead in turn to tissue damage and cell death, with a sore starting as a painful red-coloured area which eventually turns purple. If this remains untreated for any length of time it may then break open and become infected, especially in a  moist environment.

Stage 1 pressure ulcers are mostly superficial discolouring of the skin and considered low risk. It is relatively easily treated by ensuring immediate removal of pressure to the affected area.

Stage 2 pressure ulcers involve damage to the skin layer with the appearance of a typical blister-like abrasion, able to be treated as medium risk.

Stage 3 pressure ulcers are serious and more difficult to treat, due to diminished blood supply – with the damage extending below the skin layer and forming the typical ulcer appearance.

Stage 4 pressure ulcers are the deepest level of decubitus ulcer, often extending into the muscle, tendon, or even bone. Stages 3 and 4 ulcers are considered as high risk, with a healing success rate only slightly better than 55% within 12 months of treatment.

There are many techniques used to minimise the risk of pressure ulcers in at risk groups. These include nutritional supplements, topical skin protection and mechanical devices to mimic the effect of movement, such as alternating pressure mattresses. The most commonly used method of reducing the risk of pressure ulcers is regular nursing intervention and a ‘turning schedule’ to ensure the weight of the immobile patient is redistributed, reducing sustained pressure on a vulnerable area. Keeping strict moisture control is also most important as damp, humid conditions will aggravate pressure sensitive areas.

Effective cure includes ongoing removal of dead tissue to reduce the medium for bacterial growth, which will compromise healing of the wound. This, together with systematic infection control, is currently the most effective medical intervention for decubitis ulcers (bedsores, pressure ulcers).

The individuals age and other ongoing medical conditions can greatly reflect their healing ability. A healthcare professional should always be consulted for an individuals pressure care needs, both in prevention measures and treatment needs.

Information about Pressure Care Equipment & Aids can be found here