Bedsore

Author: Vanessa Ngan, Staff Writer, 2003.


What is a bedsore?

A bedsore is an area of reddened skin that progresses to breakdown of skin and underlying tissue to form an erosion or ulcer. A bedsore is also known as a pressure sore, decubitus ulcer, pressure ulcer and pressure wound.

What causes a bedsore?

A bedsore is caused from a lack of blood flow and from mechanical stress to the skin and tissues over a bony area that has been under pressure for a prolonged period. If blood supply is cut off to an area of skin for more than 2 or 3 hours the skin is deprived of oxygen and begins to die. In addition, when slowly sliding down a bed or chair, friction to the outer skin layer such as from wrinkled bedding and clothing contribute to skin injury and ulcers. Excessive exposure to moisture such as sweat, blood, urine or faeces also increases the likelihood of bedsores.

Who is at risk of bedsores?

People whom are immobile due to illness or injury are at greatest risk of getting bedsores. These people may be wheelchair-bound or bedridden and are unable to change position without assistance. Also at risk are people whom, due to nerve damage from injury or illness such as diabetes or stroke, are unable to sense pain or signals that normally make people move. Elderly people are also at greater risk because their skin is thinner and more fragile.

What are the signs and symptoms of bedsores?

Bedsores are classified into stages according to wound severity.

Stage 1

  • Skin is unbroken but shows a pink or reddened area
  • May look like a mild sunburn
  • Skin may be tender, itchy or painful

Stage 2

  • Skin is red, swollen and painful
  • Blisters that may be broken or intact may be present
  • Upper layers of skin begin to die

Stage 3

  • Sore has broken through the skin and wound extends down to deeper layers of skin tissue
  • Crater-like ulcers are present
  • Wound is prone to infection

Stage 4

  • Sore extends past the skin and into fat, muscle and bone tissue
  • Blackened dead tissue called eschar may be seen in deep opened wounds
Severe pressure ulceration

Most people with bedsores will feel some pain and itching. However, people whom have impaired senses may not feel any pain even with severe deep sores.

What is the treatment for a bedsore?

Bedsores can be difficult to treat once they go beyond stage 2. In the early stages when the skin is still intact bedsores usually heal by themselves, once the pressure has been removed. Once the skin is broken the main aim is to prevent infection and protect the sore so that it can heal. Special dressings and honey preparations may be used to help the healing process. Occasionally dead tissue may be removed with a scalpel (debridement).

Therapeutic devices include:

  • Topical negative pressure therapy (VAC®)
  • Hydrotherapy debridement, using saline solution in a syringe or water pressure jets
  • Warming therapy, using radiant heat in a moist environment to maintain skin surface temperature of 37 to 38C

Deep bedsores are very difficult to treat and often require surgical treatment to remove dead and decaying tissue. Sometimes healthy skin may be transplanted to the damaged area. Infections need treatment with antibiotics. In severe or life-threatening situations amputation of limbs may be necessary.

Can bedsores be prevented?

Bedsores can be prevented with intensive nursing care. Measures to prevent bedsores include:

  • Correct malnutrition if present (fluid, energy, protein, vitamins and minerals)
  • Daily inspection of an immobile person's skin to detect early redness
  • Frequent repositioning of the patient (recommendation is to turn them every 2 hours)
  • Keep the skin clean
  • Special foam, fibre and gels as padding materials used on chairs and beds to relieve the pressure on bony prominences
  • Powered alternating-pressure mattresses and overlays

Prevention of bedsores is the best approach as established bedsores can be painful and life threatening. They also lengthen hospital stays and increase medical costs dramatically.

 

Related Information

References

Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.

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