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VERIFIED CONTENTAuthor: Katarzyna Wieczorek-Szukała, MD, PhD, medical biotechnologist, Medical University of Lodz

Pressure ulcers are a very common problem of immobilized patients whose sensitive areas of the body press against a hard surface. The resulting deep wounds are often infected and are difficult to heal. They can even be life-threatening! Which factors are particularly conducive to the development of pressure ulcers and what should body care look like in order to prevent their formation?

Bedsores(Latin decubitus) are areas of dead tissue that develop into ulceration of the skin, subcutaneous tissue, and over time even deeper parts of the body - muscles or bones.

There are several different factors that contribute to the formation of pressure ulcers, but the common denominator in all cases is ischemia and hypoxia in tissues in which naturally occurring metabolic processes are disrupted.

Where do bedsores come from?

One of the first steps in the formation of a later ulcer is the change in pressure in arterial microcapillaries. Our flexible blood vessels can adapt to changing pressure conditions. However, adaptation is only possible for a short time.

If the pressure in the capillaries remains above the limit value - it causes a violent reaction of the vessel narrowing (the so-called occlusion), and thus slow tissue ischemia and progressive ulceration.

This type of pressure change can mainly be caused by pressure - both when a lot of pressure is applied to the skin surface in a short time and when less pressure is applied to the body over a longer period of time.

In practice, tissue deformation may occur most frequently in patients who are immobilized in hospital beds or wheelchairs, where the body is pressed between the skeleton and the backrest.

In addition, the risk of pressure ulcers may also arise with the use of special prostheses, shoes or mechanical devices that are worn in close contact with soft tissue and cause constant irritation.

In addition to the obstructed blood flow in the compressed tissue, the lymphatic flow is also disturbed, which in turn leads to the accumulation of metabolic products ortoxins. Such a situation leads to the induction of local inflammation, which may additionally aggravate the tissue damage.

Where are the most common pressure ulcers and how to classify them?

Pressure ulcers in most cases occur in places where the skin covers the bone, and this type of "bulge" of the body touches the ground, i.e. around:

  • sacro-lumbar,
  • buttocks,
  • heels and ankles,
  • sub-tibial.

Due to the position of the body, in patients immobilized for a long time in the supine position, as much as 25% of all pressure ulcers are diagnosed in the area of ​​the lower limbs.

A special four-level scale describing the depth of the ulcer is sometimes used to assess the severity of pressure ulcers:

Grade I

These types of bedsores are superficial, and the affected area becomes red (which does not turn white when pressed with a finger, for example). In people with darker skin color, Stage I pressure ulcers can take on a bluish or light purple tinge.

The changes may be sore, warm and itchy, but the skin remains intact.

Grade II

Ulcers are deeper in nature - part of the epidermis or dermis is damaged and visibly thinner, which gives the lesion the appearance of an open wound or bladder. In this case, there is almost always swelling and severe pain.

Grade III

The ulcer appears as a deep crater-like wound with a distinct, demarcated edge. The deep skin layers are lost along the entire length of the ulcer, but the underlying muscle and bone are not damaged.

Grade IV

The most severe type of pressure ulcer. It is characterized by deep skin damage, along with necrosis of the underlying muscles, bones and joint areas. The wound turns black. Morphologically, such a lesion resembles third degree tissue burns and is very susceptible to infections.

Advanced ulcerative lesions often become open gates of infection through which pathogens easily penetrate. A patient with neglected pressure ulcers, weakened by a long-term disease, may therefore be exposed to life-threatening systemic inflammations - such as sepsis or gas gangrene (formerly known as gangrene).

Who is at risk of developing pressure ulcers?

Most people with pressure ulcers are people with long-term he alth problems - both physical and mental - who remain motionless. The most harmful isnot changing your position while lying on the bed. Therefore, patients who are paralyzed or in a coma require special care.

Some metabolic diseases - incl. type 2 diabetes - they additionally affect the blood supply to tissues and capillaries as well as wound healing, which makes these patients more prone to pressure ulcers.

Age is also an important risk factor for pressure ulcers. Most of this type of ulcer (over 65%) occurs in elderly people between the ages of 60 and 80.

Occasionally, pressure ulcers are more frequently diagnosed in immobilized patients with:

  • heart failure,
  • atrial fibrillation,
  • myocardial infarction,
  • chronic obstructive pulmonary disease (COPD).

This is because these diseases are associated with an insufficient degree of oxygenation of the body's tissues, which in turn affects the healing of bruises and wounds.

The overall body weight of the patient undoubtedly also plays a large role - in obese people, protruding parts of the body are exposed to greater pressure on the ground.

One of the underestimated factors that determine the formation of pressure ulcers is a diet low in macro- and micronutrients. People who are malnourished, anemia or dehydrated often struggle with additional skin problems and difficult to heal ulcers.

The skin of the chronically ill also badly tolerates too humid conditions and pollution, e.g. as a result of:

  • urinary incontinence,
  • profuse diarrhea,
  • intense sweating.

Areas of the body that are in frequent contact with body secretions, in the absence of proper hygiene, are also more prone to burns, irritation and the formation of pressure ulcers.

How to prevent pressure ulcers?

In the prevention of bedsores, the most important thing is to eliminate the causative agent that deepens the formation of the wound, and therefore most often:

  • strong pressure,
  • shear force (in case of inadequately selected entities or prostheses),
  • friction (caused by belts or too rough material).

One of the best ways to prevent pressure ulcers are special mattresses, overlays and anti-bedsore pillows. These types of aids can be divided into special chambers filled with variable pressure inside and equipped with a pump. As a result, they have a much more gentle effect on the body of the immobilized patient and support ventilation.

An invaluable role in prophylaxis is played by meticulous and frequent verification of the patient's skin condition.The body of a person at risk of developing pressure ulcers should be checked for damage or redness (especially over sensitive areas) even two or three times a day.

All physiotherapeutic treatments supporting blood circulation bring excellent results:

  • massages,
  • lymphatic drainage,
  • gentle strain relief exercise.

The surface of the body in areas exposed to wounds should always be clean and dry. Special, non-irritating cosmetics should be used for the care of sensitive skin. Too greasy cream formulas and alcohol-containing agents are certainly inadvisable, as they may cause drying of the skin and additional deterioration of its condition.

You should also not forget about appropriate, preferably light and airy clothes - made of natural fibers such as linen or cotton. Unfortunately, even very decorative synthetic materials and the strong dyes they contain can cause very strong allergic reactions, especially in contact with excessive sweat and body secretions.

Proper healing of wounds and regeneration of the body also requires an appropriate, nutritious diet, preferably rich in protein. Chronic malnutrition, especially in the elderly, several times increases the risk of pressure ulcers and deterioration of the skin condition.

Daily meals should be varied and provide a complete set of vitamins, minerals as well as mono- and polyunsaturated fats, present e.g. in olive oil, nuts or fatty sea fish. In the case of difficult nutrition of the patient, food for special medical purposes in the form of nutritious cocktails and vitamin supplements may be helpful.

How are already existing bedsores treated?

If an ulcer has already occurred, the most important part of treatment is thorough cleaning and drying of the wound and careful skin care.

Cleaning involves not only removing all surface contamination, but also surgical preparation of the wound and meticulous excision of all dead tissue. Sometimes, less conventional methods are also used for this purpose, e.g.

  • enzymes digesting dead tissue,
  • special cultures of maggots or larvae that selectively eat only dead cells,
  • low frequency ultrasound,
  • necrosis removal with a laser beam.

In the process of supporting the wound healing, a whole range of constantly modernized medical dressings is used, including

  • hydrocolloid - containing a special gel that supports the regeneration of new skin cells inulceration,
  • alginate - made of seaweed containing sodium and calcium, accelerating the healing process,
  • with nanosilver - using the antibacterial properties of silver to clean infected wounds.

Currently, in the treatment of non-complicated pressure ulcers, the use of antibiotics is avoided so as not to cause microbial resistance to strong substances. However, if the infection spreads, it may be necessary for further treatment.

The latest bedsores treatment systems are also based on the use of hyperbaric oxygen therapy. Patients breathe pure oxygen in special hyperbaric chambers during several-minute sessions. This type of therapy is often very effective in the treatment of difficult-to-heal wounds and recurrent ulcers that do not respond to other treatments.

Following the principle that prevention is better than cure - when caring for a patient at risk of developing pressure ulcers, it is best to introduce appropriate prophylaxis methods as soon as possible.

Properly moisturized and nourished skin will be much less susceptible to pressure and will remain he althy for a long time. Neglected pressure ulcers are not only difficult to treat, but also pose the risk of serious complications that can even be life-threatening.

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