Medicosnext
What is pressure ulcer?
Normally, as this type of wound develops in patients who have been lying in ICU beds for a long period, or in old age, or people who have been bound to the bed or wheelchair with homecare due to their chronic debilities, it was in the past named as bedsore. Continuous pressure at one point of the body for long periods is the main cause; therefore these usually develop in persons who are either confined to bed or who sit in a chair or wheelchair for long periods of time. Thus, pressure ulcer is a localized soft-tissue (skin and underlying tissues) injury from unrelieved pressure, usually over a bony prominence. It is also known as decubitus ulcer or pressure sore.
How does a pressure ulcer occur?
Depending upon the ischemia tolerating point of the tissue, the compression results in transient ischemia, and if the pressure is What is pressure ulcer?
Normally, as this type of wound develops in patients who have been lying in ICU beds for a long period, or in old age, or people who have been bound to the bed or wheelchair with homecare due to their chronic debilities, it was in the past named as bedsore. Continuous pressure at one point of the body for long periods is the main cause; therefore these usually develop in persons who are either confined to bed or who sit in a chair or wheelchair for long periods of time. Thus, pressure ulcer is a localized soft-tissue (skin and underlying tissues) injury from unrelieved pressure, usually over a bony prominence. It is also known as decubitus ulcer or pressure sore.
How does a pressure ulcer occur?
Depending upon the ischemia tolerating point of the tissue, the compression results in transient ischemia, and if the pressure is not relieved beyond that period, then it will lead to necrosis of the soft tissue, and ultimately ulceration develops even in a well-vascularized area. If the pressure is more than the capillary pressure (32 mmHg) and is continuous at one point for more than two hours, then it will cause irreversible damage, leading to the development of pressure ulcer, and if we can relieve that pressure even for five minutes within that period, then this could be prevented.
What are the signs and symptoms of pressure ulcer?
The early symptoms are:
a. Discoloration (red patches) of the skin
b. Pain or itchiness in the affected area
c. Feeling of warm, spongy, or hard at the affected area
The late symptoms are:
a. Development of blister or open wound
b. Development of ulcer or a small hole with foul smelling discharge
What are the contributing factors in addition to the unrelieved prolonged pressure for the development of pressure ulcer?
Old age, moisture either due to sweating or soiling with urine or stool, immobility, malnutrition, spasticity, friction, and shear force while re-positioning single handedly, and obesity are the key contributing factors, in addition to
the pressure, in developing pressure ulcer.
Who are at risk of developing pressure ulcer?
Anyone can develop a pressure ulcer if allowed to stay in one position for prolonged periods, but those who are at risk are:
a. Old age persons with mobility problems and fragile skin
b. Persons confined to bed with illness, or after surgery
c. Paralyzed persons
d. Obese patients
e. Patients with urinary and/or bowel incontinence
f. Malnourished people
g. People with medical conditions like diabetes, peripheral arterial disease, heart failure, and kidney failure.
What are the stages of pressure ulcer?
National Pressure Ulcer Advisory Panel Staging system, in 2007, had added two additional stages on top of the original four stages. Stage I includes intact skin with non-blanching erythema, Stage II includes partial-thickness loss of the skin, Stage III includes full thickness loss of the skin, and Stage IV includes deeper injuries, including either muscles, tendon, or bone. Added stages include Deep Tissue Injury characterized by maroon localized intact
skin or blood-filled blister, and Unstageable, which is a full thickness ulcer with eschar at the base.
How can one prevent pressure ulcers from developing?
It may be difficult to completely prevent pressure ulcers from developing, but the following can be done to reduce the risk:
a. Changing the position regularly at an interval of less than two hours and gentle massaging the pressure pointed side.
b. Checking the skin every day for early signs and symptoms of pressure ulcer development.
c. Building up nutrition with enough protein in the diet.
How to manage a pressure ulcer?
The targeted goals of management for pressure ulcer are 1) preventing the existing ulcer from getting larger, 2) preventing the development of ulcer at other location, 3) prevention of complications, and 4) closure of
the wound. For the successful treatment of the pressure ulcer, the key components include building up the nutrition, complete relief of the pressure, control of spasm and contractures, resolution of infection, and correction of
comorbidities.
For the closure of the wound, debridement of the devitalized tissue is primary, followed by different types of local or regional flaps, depending upon the location of the pressure ulcer. Post-operative care is vital for the success of the
treatment, along with prevention of development of another pressure ulcer.
Is non-surgical treatment an option for management of pressure ulcer?
In patients who can’t undergo surgical debridement and closure, non-surgical treatment is the only available option,
though it is cumbersome and time taking. We can use ointments with the property to slough-out or erode the
devitalized tissue initially and then use of the collagen-based powder or ointment for promoting the growth
of the granulation tissue along with preventive measures taken into account.
What are the complications of pressure ulcer?
The recurrence if not cared properly, and development of cancer (Marjolin ulcer), are the long term complications
of pressure ulcer.
