Bedsores, also called decubitus ulcers, pressure ulcers, or pressure sores, begin as tender, inflamed patches that develop when a person's weight rests against a hard surface, exerting pressure on the skin and soft tissue over bony parts of the body. For example, skin covering a weight-bearing part of the body, such as a knee or hip, is pressed between a bone and a bed, chair, another body part, splint, or other hard object. This is most likely to happen when the person is confined to a bed or wheelchair for long periods of time and is relatively immobile. Usually, mobile individuals, when either conscious or unconscious, will receive nerve signals from the compressed part of the body and will automatically move to relieve the pressure. Pressure sores do not usually develop in people with normal mobility and mental alertness. However, people compromised through acute illness, heavy sedation, unconsciousness, or diminished mental functioning, may not receive signals to move, and as a result of the constant pressure, tissue damage may progress to bedsores in these individuals.
Each year, about one million people in the United States develop bedsores at a treatment cost of $1 billion. Pressure sores are most often found in elderly patients; records show that two thirds of all bedsores occur in people over age 70. People who are neurologically impaired, such as those with spinal injuries or paralysis, are also at high risk. Pressure sores have been noted as a direct cause of death in about 8% of paraplegics.
In 1992, the Federal Agency for Health Care Policy and Research reported that bedsores afflict:
Bedsores range from mild inflammation to ulceration (breakdown of tissue) and deep wounds that involve muscle and bone. This painful condition usually starts with shiny red skin that quickly blisters and deteriorates into open sores. These sores become a target for bacterial contamination and will often harbor life-threatening infection. Bedsores are not contagious or cancerous, although the most serious complication of chronic bedsores is the development of malignant degeneration, which is a type of cancer.
Bedsores develop as a result of pressure that cuts off the flow of blood and oxygen to tissue. Constant pressure pinches off capillaries, the tiny blood vessels that deliver oxygen and nutrients to the skin. If the skin is deprived of essential oxygen and nutrients (a condition known as ischemia) for even as little as an hour, tissue cells can die (anoxia) and bedsores can form. Even the slightest rubbing, called shear, or friction between a hard surface and skin stretched over bones, can cause minor pressure ulcers. They can also develop when a patient stretches or bends blood vessels by slipping into a different position in a bed or chair.
Since urine, feces, or other moisture increases the risk of skin infection, people who suffer from incontinence, as well as immobility, have a greater than average risk of developing bedsores.
Unfortunately, people who have been successfully treated for bedsores have a 90% chance of developing them again. While the pressure sores themselves can usually be cured, about 60,000 deaths per year are attributed to complications caused by bedsores. They can be slow to heal, particularly when the patient's overall status may be weakened. Without proper treatment, bedsores can lead to:
Bedsores are most apt to develop on bony parts of the body, including:
Although impaired mobility is a leading factor in the development of pressure sores, the risk is also increased by illnesses and conditions that weaken muscle and soft tissue, or that affect blood circulation and the delivery of oxygen to body tissue, leaving skin thinner and more vulnerable to breakdown and subsequent infection. These conditions include:
Physical examination , medical history, and patient and caregiver observations are the basis of diagnosis. Special attention must be paid to physical or mental problems, such as an underlying disease, incontinence, or confusion that could complicate a patient's recovery. Nutritional status and smoking history should also be noted.
The National Pressure Ulcer Advisory Panel (NPUAP) recommends classification of bedsores in four stages of ulceration based primarily on the depth of a sore at the time of examination. This helps standardize the language and encourages effective communication of medical personnel caring for patients with bedsores. The NPUAP advises that not all bedsores follow the stages directly from I to IV. The four most widely accepted stages are described as:
In addition to observing the depth of the wound, the presence or absence of wound drainage and foul odors, or any debris in the wound, such as pieces of dead skin tissue or other material, should also be noted. Any condition that could likely contaminate the wound and cause infection, such as the presence of urine or feces from incontinence, should be noted as well.
A doctor should be notified whenever a person:
Immediate medical attention is required whenever:
Prompt medical attention can prevent surface pressure sores from deepening into more serious infections. The first step is always to reduce or eliminate the pressure that is causing bedsores. For minor bedsores, stages I and II, treatment involves relieving pressure, keeping the wound clean and moist, and keeping the area around the ulcer clean and dry. This is often accomplished with saline washes and the use of sterile medicated gauze dressings that both absorb the wound drainage and fight infection-causing bacteria. Antiseptics , harsh soaps, and other skin cleansers can damage new tissue and should be avoided. Only saline solution should be used to cleanse bedsores whenever fresh non-stick dressings are applied.
The patient's doctor may prescribe infection-fighting antibiotics , special dressings or drying agents, and/or lotions or ointments to be applied to the wound in a thin film three or four times a day. Warm whirlpool treatments are sometimes recommended for sores on the arm, hand, foot, or leg.
Typically, with the removal or reduction of pressure in conjunction with proper treatment and attention to the patient's general health, including good nutrition, bedsores should begin to heal two to four weeks after treatment begins.
Surgical options are often considered for non-healing wounds. When deep wounds are not responding well to standard medical procedures, consultation with a plastic surgeon may be needed to determine if reconstructive surgery is the best possible treatment. In a procedure called debriding, a scalpel may be used to remove dead tissue or other debris from Stage III and IV wounds. A surgical procedure called urinary (or fecal) diversion may also be used with incontinent patients to divert the flow of urinary or fecal material—this keeps the wound clean and encourages wound healing. Reconstruction involves the complete removal of the ulcerated area and surrounding damaged tissue (excision), debriding the bone, and reducing the amount of bacteria in the area with vigorous flushing (lavage) with saline solution. The surgical wound is then drained for a period of days until it is clear that no infection is present and that healing has begun. Plastic surgery may follow to close the wound with a flap (skin from another part of the body), providing a new tissue surface over the bone. For surgery to succeed, infection must not be present. Complications can occur after reconstructive surgery; these include bleeding under the skin (hematoma), wound infection, and the recurrence of pressure sores. Infection in deep wounds can progress to life-threatening systemic infection. Amputation may be required when a wound will not heal or when reconstructive surgery is not an option for a particular patient.
Zinc and vitamins A, C, E, and B complex provide necessary nutrients for the skin and help it to repair injuries and stay healthy. Large doses of vitamins or minerals should not be used without a doctor's approval.
A poultice made of equal parts of powdered slippery elm ( Ulmus fulva ), marsh mallow ( Althaea officinalis ), and echinacea blended with a small amount of hot water can relieve minor inflammation. An infection-fighting rinse of two drops of essential tea tree oil (Melaleuca) to every 8 oz (0.23 g) of water can also be administered. An herbal tea made from calendula ( Calendula officinalis ) is also an effective antiseptic and wound healing agent. Calendula cream can also be used.
Contrasting hot and cold compresses applied to the bedsore site can increase circulation to the area and help flush out waste products, speeding the healing process. The temperatures should be extreme (very hot and ice cold), yet tolerable to the skin. Hot compresses should be applied for three minutes, followed by 30 seconds of cold compress application, repeating the cycle three times. The cycle should always end with a cold compress.
It is usually possible to prevent bedsores from developing or worsening. In 1989, the NPUAP set a goal that pressure sores be reduced by 50% by 2000. Because of the varying ways in which the number of cases were recorded during this timeframe, the NPUAP is finding it difficult to analyze accurate incident accounts. However even with the diversity of recording methods and the difficulties in comparing data, small group data indicates that progress has been made with the standardization of guidelines and care.
All patients recovering from illness or surgery or confined to a bed or wheelchair long-term should be inspected regularly; they should be bathed or should shower every day using warm water and mild soap; and patients should avoid cold or dry air. Bedridden patients who are either mentally unaware or physically unable to turn themselves, must be repositioned regularly by caregivers at least once every two hours while awake. People who use a wheelchair should be encouraged to shift their weight every 10 or 15 minutes, or be repositioned by caregivers at least once an hour. It is important to lift, rather than to drag, a person being repositioned. Bony parts of the body should not be massaged. Even slight friction can remove the weakened top layer of skin and damage blood vessels beneath it.
If the patient is bedridden, sensitive body parts can be protected by:
Pillows or foam wedges can prevent a bedridden patient's ankles from irritating each other, and pillows placed under the legs from mid-calf to ankle can raise the heels off the bed. Raising the head of the bed slightly and briefly can provide relief, but raising the head of the bed more than 30 degrees can cause the patient to slide, thereby causing damage to skin and tiny blood vessels.
A person who uses a wheelchair should be encouraged to sit up as straight as possible. Pillows behind the head and between the legs can help prevent bedsores, as can a special cushion placed on the chair seat. Donutshaped cushions should not be used because they restrict blood flow and cause tissues to swell.
Special support surfaces are manufactured and readily available for care in medical facilities or at home, including: air-filled mattresses and cushions, low-air loss beds, and air-fluidized beds. These devices give adequate support while reducing pressure on vulnerable skin. They have been shown to exert less pressure on the skin of compromised patients than do regular mattresses. Patients using these devices and beds must still be repositioned every two hours.
International Association of Enterstomal Therapy. 27241 La Paz Road, Suite 121, Laguna Niguel, CA 92656. (714) 476-0268.
National Pressure Ulcer Advisory Panel. 12100 Sunset Hills Road, Suite 130, Reston, VA 20190. (703) 464-4849. http://www.npuap.org .
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Maureen Haggerty
L. Lee Culvert
Thanks
She is supposed to go in and have the hip totally replaced but now since she has the sore she is unable to do that. We are waiting for it to heal and actually I am quite concerned about all this.
with regards
Thank You, Mandie
As he explained it, the "gold standard", (his words), in surgery for repairing bedsores involves moving adjacent muscle to compensate for the lost skin etc., and closing up the wound. For a successful outcome the patient must be strong, nutritionally healthy and in particular have a good level of protein. After 5 months in hospital fighting 3 post surgery hospital acquired infections - (C-Diff, MRSA and VRE) - my husband is none of the above.
The surgeon has chosen instead to do what sounds a little like debriding but more thorough. It apparently involves scraping dead tissue, washing well and the emplacement of a manually emptied draining tube in the wound. (I hope this way of draining works well. I know that the very expensive Wound Vac we had been renting was useless.) Our surgeon specializes in these wounds and says the overall success rate for this type of surgery and treatment is about 70%, healing time about 3-4 weeks.
I need to find out if this is negligence - you would think the best care would be in ICU where this started - please someone help put my mind at ease thank you
I am getting ready to start the Dermawound product it was a $119 for 3 jars I don't think that is to much if it works I will try and keep you informed if it works
Hospice comes tomorrow we will see what they have to say they don't see it every day
I am now fighting pressure points on both hips
I feel like I am fighting a losing battle
she will rest in peace
i am 33 old male that broke my back t7 t8 in 94 i gt a bedsore in late 2008 and did the antibodies the vac eating HIGH Protien everyday Meat fish Shakes everything and the vac pump and am very active fact that im incomplet para i hurt like CRAZY i have 2 kids 7yoBoy 9yogirl and with limited help i get up and drag my but every where and last year in late nov i now am the owner of another bedsore my infection had also moved in the bone ive chatted with someone lately and says i need to have dead bone cleaned out and a musle pull and skin graph this i dont know anything about and in some cases are told i wont get better but i have too . . . please anybody that knows enough about this plz reply. . . . ps/ do doctors read this ?
many thanks,
Lena Bowen
IT HAS BEEN 18 MONTHS NOW AND THE WOUNDS HAVE CLOSED,ONE STILL FEELS A BIT AS THOUGH ITS A BIT HOLLOW UNDERNEATH,BUT THE NURSES SAY ITS OKAY BUT HAS TO BE COVERED WHEN WE GO OUT FOR A SHORT TIME IN THE WHEELCHAIR,SHE DRINKS AND EATS WELL AND HAS PUT ON WEIGHT,I DO ALL THE USUAL THINGS YOU ARE SUPPOSED TO DO WITH SOMEONE IS CONFINED TO BED,MY QUESTION IS,IS THERE ANYTHING I CAN PUT ON HER BUTTOCKS TO HELP TO KEEP THE SKIN IN GOOD CONDITION.
sincerely,
a abandoned daughter, mrs. criss
my father is 48 years old.he is paralyze last 27 years and he is facing bedsores problem last 22 years.
we have done lots of surgery and we have tried lots of medicines but still he is facing same problem.
I am a student and I am not belong to a very rich family. but I just want to give treatment to my father.
I don't know what I should do.
please guide me what I should do.
please...
this is how I treated it the hole was 5 inch all way round 2 inch deep don't attempt this unless you wear rubber gloves don't let any water get to it i used cotton wool buds to get as much pus out as I could I did it twice a day over a week every time I got small amounts out put sterile gauze over it taped it up till I got all the pus out.
I got some Bovril and marmite from our stores put it inside the hole packed it with gauze not too much gauze it doesn't stick into the sore put micro tape over it left it on over night it smelt aweful when I went on my day shift did that for nearly a month you could see the hole slowly getting smaller belive me it worked both of the ingredients I used feed the bed sore to make it heal I got it down to half an inch.
useing less and less i had a weeks holiday left instruction's for the nurses to keep up to doing the same through the day went back after my holiday to face a gapping 3 inch hole no one had bothered just covered it with gauze so started again till I got the hole completely healed i kept turning her as she was so frail every hr I was on my shift I couldn't belive how much that poor women had gone through she had deteriated so much before we got her never been out of bed when I was satisfied it had knitted together I sat her in a chair for half an hr for a few days till she got a bit of strength i helped her to take a few steps to walk.
she and her family couldn't belive what I achieved for her and thanked me for all the time I stuck at it for her to this day I still think about her sadly she did pass away after I retiered she lived till she was 95yrs old but I can honestly say she never had another bedsore with her having TB she could only walk in her cubicle she also put a bit of weight on her family came to see me to ask if I wanted to go to her funeral she was a lovely old lady. so if any one as the patence to try this I can assure you it did work and it was something I thought of myself.I do hope some one will try this and let me no if it works for some one you have suffering a really bad bedsore like she did.
I am a 64 year old male, in excellent health. In October of 2014 I was in a car crash and in December of 2014 I tripped on a broken sidewalk and smashed my patella.
Since that time I have developed pressure sores. One is addressed, that another one pops up a few weeks later, almost overnight. I am 5'11", 170 pounds, as active as I can be in my current state, don't sit for long periods, etc. Am I doing something wrongs?
Let me know if you have a chance.
We are all in the family are so scared & we do not know how treat the same. Please provied the information about home treatment for bedscore.
How to treat bed sore.
What medicine should be treated for bed sore.
Any body suggest to treat bed sore and fast recovery.
Giving Ceftriaxone Inj-1gm BID along with Amikacin Sulph-500mg BID since three days.
We are all in the family are so scared & we do not know how treat the same. Please provied the information about home treatment for bedscore.
we have tried applying allovera gel everyday and cleaning with scilen water.
kindly give us sum home remedies