BED SORES
Pressure sores (also referred to as Pressure Ulcers, Bed Sores or a Decubitus Ulcer) can be quite common in persons who are confined to a bed or wheelchair for extended periods of time. People living with spinal cord injuries are at greatest risk since they have lost sensation in parts of their body, and therefore are missing the signals that tell them to shift position.
Additional risk factors for people who are unable to move parts of their body without help can include age; body thinness or weight loss; incontinence; malnutrition and nursing home care (highest incidence of development as compared to in home or hospital provided care).
STAGES of DEVELOPMENT Bed sores can develop quickly; rapidly progress through four stages of development; and can be difficult to heal, especially if progression has reached the third and fourth stages. In Stage 1 of pressure ulcers, the skin will appear to be red – and may itch. In this stage, the bed sore will usually disappear after the pressure is relieved. However, at Stage 2, some skin loss has usually occurred. In this stage, the decubitus ulcer may look like a blister or an abrasion, and the area around the sore may show signs of red or purple discoloration. At this stage, the pressure ulcer can usually be healed after a short period of time (days, weeks or months) once the pressure is relieved. By Stage 3, pressure ulcers become more serious and require immediate attention to avoid slipping into Stage 4. In Stage 3, the injury can extend into the subcutaneous tissue layer. Blood supply to these tissues is limited, and therefore bed sores can be difficult to heal when at this stage. The ulcer can take the appearance of a deep, crater-like wound.
Statistically, once Stage 4 is reached, the likelihood of bed sores healing drops significantly. At this point, the recovery rate within one year is just slightly over 50%, and about 40% will never heal without other types of medical intervention. CAUSES The sustained pressure on delicate, soft tissue that is exerted between an external surface (i.e. bed) and the internal skeptical structure can diminish blood flow to these tissues. Over time, the lack of sufficient oxygen and nutrients to these body tissues can cause them to die. Areas of the body that are not well padded with muscle and fat are especially prone to developing bed sores (i.e. spine, tailbone, shoulder blades, hips, heels and elbows). Besides pressure, friction and shearing effects can also contribute to the likelihood of at risk patients developing pressure ulcers. PREVENTION Obviously, the easiest way to avoid bed sores is to make sure that a person confined to a bed or wheelchair is moved or repositioned frequently. In addition, if incontinence (excess moisture) is contributing to the problem, this too needs to be addressed. The use of appropriate support devices, pressure-reducing mattresses and pressure-release wheelchairs can help reduce the pressure on affected areas. Proper bathing and lifting devices should also be a part of any prevention program in order to reduce the likelihood that shear and friction will play a part in the development of a decubitus ulcer. TREATMENT Stage 1 and 2 sores will usually heal after the prevention techniques explained above are implemented. However, more aggressive treatment is usually required for Stage 3 and 4 ulcers. Treatment at these higher levels will usually include debridement. Several different debridement (tissue removal) options are available to your doctor. Surgical debridement is the most popular approach used by doctors as it allows them to quickly remove the dead tissue with minimal discomfort to the patient. Other methods of tissue removal can include mechanical debridement (high pressure irrigation), autolytic debridement (body’s own enzymes augmented with moist dressings), and enzymatic debridement (prescribed topical enzymes). There are numerous complications that can develop from a decubitus ulcer if left untreated. Most of these are related to ensuing bacterial infections. Cellulitis (infection of the skin’s connective tissue), bone/joint infections, sepsis (bacteria enter the bloodstream and spread throughout the body), myonecrosis (rare form of gangrene) and necrotizing fasciitis (infection that destroys the layers of tissue surrounding muscle) are some of the more serious infections that can develop. Left untreated or not treated appropriately, some of these can result in long-term infections, or death. A case and point is the well known actor, Christopher Reeve who was confined to a wheelchair after a permanent spinal cord injury. Technically, he died of an infection, but the infection was caused by pressure ulcers that progressively worsened over time. Return from Bed Sores to Skin Rash Page
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The last stage of development is Stage 4. By this time, a significant loss of skin has occurred, and the resulting tissue damage can extend down into muscle, bone and tendons.
