Bedsores

DEFINITION

Bedsores are the areas of dead and damaged skin that happen as a result of sustained pressure cutting off circulation to certain areas of the body. Bedsores are also commonly called pressure sores or pressure ulcers. The most common locations for these types of sores are the low back (just above the buttocks), the buttocks, the hips, and the heels. As with all other tissues in the body, when blood supply is cut off, the tissue begins to die. Other factors that contribute to pressure ulcers include: being bedridden (as with quadriplegia or debilitating illness), friction and shear forces on the skin due to turning and sliding in the bed. Other risk factors for bedsores include being older, living in a nursing home, not being able to feel pain (due to spinal cord injury or other causes), being thin or losing weight, having poor nutrition (especially of protein, vitamin C and zinc), urinary or fecal incontinence, smoking, and altered mental status (not being in tune with reality). Pressure ulcers are graded or “staged” based on the depth into the skin with stage IA being the most shallow, affecting only the top layer of skin and stage IV being the deepest, down to the bone. Complications of pressure ulcers include infection of the skin (cellulitis), deeper infections in the bones or joints (osteomyelitis or septic arthritis), severe infection in the blood (sepsis), and cancer of the skin of the affected area. Preventing pressure ulcers is extremely important. Prevention entails keeping pressure off certain areas by using soft bedding supplies and supports as well as alternating the areas of pressure by frequent turning. Keeping heels off of the bed with a pillow under the legs can also help prevent heel ulcers. As with many other illnesses, the most important objective with pressure ulcers is prevention.

SYMPTOMS
Ulceration of dependent areas of the skin (back, buttocks, heels, ankles, or other areas), red or purple color of the affected skin, pain of the affected skin, pus-filled wound in the affected area

DIAGNOSIS
The diagnosis of a bedsore begins with a discussion of your medical history and a thorough physical examination by your doctor. Your doctor will closely examine your skin both in the area of the wound and to check for other possible wounds. At the area of the sore, your doctor will measure the size of the wound and how deep it goes. If pus is present, your doctor may take a sample to check for bacteria. If your doctor suspects that you have an infection deeper in the body, your doctor may want to take samples of your blood to check. If your doctor suspects involvement of your joints or bones your doctor may want to take pictures with X-ray, CT scan or MRIs. Your doctor may have you see a specialist to take a deep sample of the tissue from the bone in order to see if it is infected and with what organism.

TREATMENT
Treating bedsores depends on the severity of the ulcers. If they are not very severe, your doctor may recommend conservative management which involves frequent turning and keeping pressure off of the areas that are affected with soft supports. Cleaning these areas may also help prevent infection. Keeping the affected areas clear of urine and feces also helps to prevent further degradation of the skin. Your doctor may recommend surgical removal of the affected skin (debridement). During debridement, the surgeon may use a scalpel to cut away dead tissue and use saline to irrigate the area and clean it out. Removing the dead tissue helps the healthy tissue grow back and replace the unhealthy tissue. Many types of dressings may be applied to the wound to help speed healing and prevent infection. Generally, it is important to keep more severe wounds wet with saline (to prevent infection) and keep the surrounding skin dry. Your doctor may recommend additional treatments including whirlpool bath therapy (hydrotherapy) and healthy diet. Your doctor may also prescribe antibiotics if he or she thinks you also have an infection in the affected skin. Some more severe pressure ulcers may require more extensive surgical intervention by a general surgeon. Once pressure ulcers progress, treatment can be difficult and may not be successful. Preventing pressure ulcers by frequent turning and soft supports of the areas which bear weight frequently is very important. Special hospital bed are available that decrease pressure on the back. If you or a loved one is at risk for pressure ulcers, make sure to check the skin frequently for beginning signs of pressure ulcers, like reddening of the skin. Eating a good diet is also very important to prevent pressure ulcers. For those who are very ill, eating may be difficult. Eating smaller meals and not drinking a lot of liquids may help. You can also try protein supplements and eating pureed or liquid meals that are high in calories. To prevent pressure ulcers, you should also get regular exercise and quit smoking if you do.