Pressure sores develop as a result of constant pressure on a particular area of the body that reduces blood supply to the skin and causes the death of the underlying tissue.

Remaining in one position, such as sitting in a wheelchair or lying in bed, can create pressure sores, also known as decubitus ulcers or bedsores. Areas more prone to sores are those where bone comes in close contact with skin, such as the ankles, back, elbows, heels, and hips.

There are several risk factors for someone developing pressure sores:

• Not receiving attentive care at a nursing home

• Weight loss because of sickness or hospitalization

• A diet deficient in protein, zinc, and vitamin C

• Urinary or fecal incontinence, which causes the skin to remain moist and get infected

• Medical conditions such as diabetes or vascular diseases that affect blood circulation and increase the risk of tissue damage

• Decreased awareness because of mental disabilities or medications

• Inability to move certain body parts due to paralysis or neuromuscular diseases

• Elderly people, especially those over 70, tend to have thinner skin and decreased blood circulation due to aging. This makes them prone to developing pressure sores.

Additionally, any situation in which there is prolonged pressure, traction, friction, moisture (such as skin in contact with urine, feces or sweat), and inadequate nutrition places a person at greater risk of bedsores.

There are four stages of severity, classified according to the extent of the bedsores:

• Stage One: There is a persistent area of red, blue, or purple (depending on skin tone).It is typically warm to the touch and hurts, itches or burns.

• Stage Two: Partial skin loss begins, and the ulcer looks like an abrasion, blister, or shallow crater. The epidermis and dermis can both be affected, revealing red or purple discoloration.

• Stage Three: Full skin loss occurs, which damages the tissue below the skin and creates a crater-like appearance. The wound is deeper with blackish edges.

• Stage Four: Heavy skin loss occurs because of extensive tissue death. There is also damage to muscle, bones, and joints or tendons. The wound is very large and prone to infection.

Treatment and Management

Stage one and two bedsores need several weeks to heal with conservative treatment, in which the patient’s position must be changed often to both help existing sores heal faster and to prevent new ones. If the patient is in a wheelchair, they must be shifted every 15 minutes, or if they are in bed, once every two hours.

When repositioning the patient, any friction that could occur between the wound and a surface must be avoided, so some padding or covering should be provided. Other support surfaces, such as special cushions, pads, mattresses and beds can be utilized to bring relief to existing sores and prevent further tissue damage.

In stages three and four, simply providing conservative treatment might prove to be ineffective. Doctors may recommend surgical options instead. After the damaged skin is removed, the surgeon will perform a flap reconstruction, similar to a skin graft to restore the appearance, as well as prevent or treat infection.

But at any stage, cleaning the wounds to prevent infection is essential. It is important to keep the wound moist but the surrounding skin dry. Sores in stage one can be washed using water and a mild soap and do not need to be covered. Stage two sores require semi-permeable dressings to retain moisture and encourage skin cell growth, and they also need to be cleansed with saline solution.

For stages three and four, the dead tissue needs to be removed so a technique called debridement is required. There are three different types of debridement a doctor can perform:

• Mechanical debridement, which uses an irrigation device to break down tissue

   

• Autolytic debridement, when the body’s own enzymes breaks down dead tissue

   

• Enzymatic debridement, or the application of topical enzymes for removing dead tissue.

Hydrotherapy in whirlpool baths can also help remove contaminated tissue and clean the wound. Following a nutritious diet rich in vitamin C and zinc, can also help speed wound healing.

Despite care and cautionary hygienic measures, infection can set in if there is an open sore. Signs of infection include:

• A foul odor

   

• Redness or tenderness surrounding the sore

   

• Thick yellow or green pus

If the patient has fever, chills, confusion, weakness, or rapid heartbeat, the infection might have spread throughout the body.

If signs of infection are present, a doctor should be consulted immediately. Besides treating the infection, the physician needs to determine if medical complications have set in.

Depending on the extent of infection, either local or intravenous antibiotics will be prescribed.

Prevention

Pressure sores are preventable if a family member or caregiver makes sure no part of one’s body is exposed to prolonged pressure. Skin should be kept clean and dry, and it should be checked regularly for color changes or spots.

Appropriate seat cushions, beds, or mattresses must be used for wheelchair-bound or bedridden individuals. Caretakers need to reposition those who cannot move every two hours, and they should also make sure their sheets are kept clean and dry. When they position the patient, they should also make sure the patient is not laying directly on their hipbones and that their legs are properly supported.

Furthermore, with the help of a physical therapist, doing certain exercises can help improve blood flow.