Author: Vanessa Ngan, Staff Writer, 2003.
A pressure ulcer is an area of reddened skin that progresses to breakdown of skin and underlying tissue to form an erosion or ulcer, and is due to persistent pressure on the affected area. A pressure ulcer is also known as a bed sore, decubitus ulcer, pressure wound and pressure ulceration.
A pressure ulcer is caused by a lack of blood flow due to mechanical stress on the skin and tissues over a bony area that has been under pressure for a prolonged period. If the blood supply is cut off to an area of skin for more than 2–3 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 ulceration. Excessive exposure to moisture, such as sweat, blood, urine or faeces, also increases the likelihood of developing a pressure ulcer.
People whom are immobile due to illness or injury are at greatest risk of getting a pressure ulcer.
Pressure ulcers are classified into stages according to wound severity.
Most people with a pressure ulcer will feel some pain and itching. However, people who have impaired senses may not feel any pain even with a severe, deep sore.
A pressure ulcer can be difficult to treat once it has gone beyond stage 2. In the early stages when the skin is still intact, a pressure ulcer usually heals by itself if 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. Dead tissue may be removed with a scalpel (debridement).
Therapeutic devices used to treat a pressure ulcer include:
Deep pressure ulcers are very difficult to treat and often require surgical treatment to remove dead and decaying tissue.
Pressure ulcers can be prevented with intensive nursing care. Measures to prevent pressure ulcers include:
Prevention of pressure ulcers is the best approach, as an established pressure ulcer can be painful and even life threatening. It may also lengthen hospital stay and markedly increase medical costs.
Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
emedicine, the online textbook:
Pressure ulcers – NICE quality standard, June 2014
See the DermNet NZ bookstore.
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