May 19, 2006 12:00 am
A sore, or ulcer, caused by prolonged pressure against the skin and underlying tissue. The pressure cuts the blood flow to the affected area; the resulting ulcer can be extremely painful, and if left untreated may lead to such serious consequences as amputation or even life-threatening blood poisoning. Pressure sores are also known as “decubitis ulcers,” although in its strictest sense the latter term applies only in people who are “lying down” (the literal meaning of “decubitis”). A bedsore is a common example.
Pressure sores often develop in tissue around bony prominences, such as the elbows, tailbone, or greater trochanters (the two bones we sit on). They occur most commonly in people with diminished sensation and impaired blood flow who are bedridden or in wheelchairs, especially people in hospitals and nursing homes, who spend extended periods sitting or lying down. Diabetes increases the risk of pressure ulcers because of its association with nerve damage (neuropathy) and poor circulation. In general, people who have diminished sensation may not notice the constant pressure on their tissues and thus not feel the need to shift position. Poor circulation can cause the skin and underlying tissues to become damaged more easily. People unable to move independently are particularly susceptible to pressure sores.
Pressure sores begin as reddened areas of skin. Eventually, blisters or breaks in the skin develop. In more advanced stages, the subcutaneous tissue under the skin may be destroyed, and the surrounding bone, muscle, tendons, and ligaments may be damaged as well.
There are a number of measures a person, or the person’s caregiver, can take to prevent full-fledged pressure sores. Bedridden patients should shift position (or be shifted if they cannot move themselves) at least once every two hours to redistribute body weight and pressure. In addition, pillows or special mattresses (such as air-filled alternating-pressure mattresses, or water or gel mattresses) can be used to relieve pressure on sensitive areas. Applying protective padding such as sheepskin to bony prominences may also help. Persons in wheelchairs can use a pressure-relieving pillow and should shift position every 10 to 15 minutes.
The caregiver should do a visual inspection every day, looking for signs of pressure sores in vulnerable areas. Skin and bedding need to be kept clean and dry, although excessively dry skin should be avoided.
Relatively minor pressure sores may heal by themselves if the pressure is removed. There are now special gels and wound dressings available that promote faster healing. In more advanced cases, damaged tissue must be removed, or debrided; this may need to be done by surgical means. If the tissue around the ulcer is infected, antibiotics may be required.
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