PRESSURE SORE
Pressure sores are usually familiar to those who are involved in the care of a bedridden individual. They are skin breakdowns and can proceed to large ulcers and result in huge medical expenses and other resources. They are a reason for the financial and mental drain.
Pressure sores can be prevented to a large extent. This requires adequate knowledge and awareness on part of both the patient and his or her caregivers. In case we are not vigilant during the care of individuals who can't move on their own, we end up having to deal with one of these sores. And when they occur, it is possible to heal them with appropriate treatment.
Pressure sore occurs due to the breakdown of the skin due to prolonged exposure to high pressures. In bedridden individuals due to prolonged periods of immobility, the small vessels which nourish the tissue remain collapsed. This leads to tissue necrosis. In normal individuals, even sleep is accompanied by frequent movements and changes in position. This leads to relief from the prolonged pressures. With changes in position, the small blood vessels open up to perfuse the tissues. This prevents a pressure sore from occurring in a healthy person. Since prolonged pressures lead to tissue necrosis, these ulcers are also known as pressure sores. And because they occur in bedridden individuals they are also referred to as bedsores. The areas most prone to pressure sores include sacrum (low back between the gluteal regions), ischium (in those who depend on wheelchairs), heels, back of elbows, back of the head, etc.
Another important risk factor for pressure sore is malnutrition. Proper nutrition is vital for tissue repair and regeneration. In the absence of adequate nutrition, there is an impaired ability of the tissue to withstand stress and undergo healing. Pressure sores are also more common in thin individuals with prominent bony prominences. Adequate nutrition is important for the prevention and healing of pressure sores.
The presence of macerated skin can lead to skin breakdown. The macerated skin can be as a result of incontinence to urine and feces. Similarly, dry skin can also result in a breakdown of the skin and formation of ulcers. Dryness can be tackled with the help of moisturizers. It is important to prevent both excess moisture and dryness of the skin.
Once a pressure sore develops, it is important to recognize them early on and start measures for early healing. The same strategies which help us prevent ulceration also help us in achieving early healing. They include frequent changes in position (at least two hourly), prevention of maceration of the skin, and ensuring appropriate nutrition. It is recommended to seek the help of a healthcare worker to help guide the treatment of the pressure sore. Neglect of a pressure sore can give rise to major complications such as spreading infection. Those involved in the care of such individuals should be mindful of the possibility of pressure sores and should inspect the sore prone areas daily for skin breakdown.
Pressure sores are graded based on their severity. Milder and early stages involve a breakdown of the skin and underlying fat. More severe grades involve the underlying muscles and bones. Milder cases can usually heal with the help of appropriate nursing care. More severe grades of pressure sores require reconstructive surgery for healing. Surgery is undertaken when the patient is appropriately nourished. Surgery for pressure sores usually involves the use of local flaps. Flaps are tissues with an intact blood supply that is moved to bring in well-vascularized tissue to the area of ulcer. Depending on the location of the ulcer various flaps are used for pressure sore surgery. The patient should be taken care, by a well-motivated nursing team. In India, most of our patients are shifted home after spending a few days at the hospital. They are then taken care of by their relatives with or without the help of health care workers. The benefits of surgery will not be long-lasting in the absence of steps taken to prevent bedsores. The steps for the prevention of sores should be strictly adhered to in the period following surgery.
A healed pressure sore helps both the patient and relatives to better cope with a situation that is already stressful.
Pressure sores can be prevented to a large extent. This requires adequate knowledge and awareness on part of both the patient and his or her caregivers. In case we are not vigilant during the care of individuals who can't move on their own, we end up having to deal with one of these sores. And when they occur, it is possible to heal them with appropriate treatment.
Pressure sore occurs due to the breakdown of the skin due to prolonged exposure to high pressures. In bedridden individuals due to prolonged periods of immobility, the small vessels which nourish the tissue remain collapsed. This leads to tissue necrosis. In normal individuals, even sleep is accompanied by frequent movements and changes in position. This leads to relief from the prolonged pressures. With changes in position, the small blood vessels open up to perfuse the tissues. This prevents a pressure sore from occurring in a healthy person. Since prolonged pressures lead to tissue necrosis, these ulcers are also known as pressure sores. And because they occur in bedridden individuals they are also referred to as bedsores. The areas most prone to pressure sores include sacrum (low back between the gluteal regions), ischium (in those who depend on wheelchairs), heels, back of elbows, back of the head, etc.
Another important risk factor for pressure sore is malnutrition. Proper nutrition is vital for tissue repair and regeneration. In the absence of adequate nutrition, there is an impaired ability of the tissue to withstand stress and undergo healing. Pressure sores are also more common in thin individuals with prominent bony prominences. Adequate nutrition is important for the prevention and healing of pressure sores.
The presence of macerated skin can lead to skin breakdown. The macerated skin can be as a result of incontinence to urine and feces. Similarly, dry skin can also result in a breakdown of the skin and formation of ulcers. Dryness can be tackled with the help of moisturizers. It is important to prevent both excess moisture and dryness of the skin.
Once a pressure sore develops, it is important to recognize them early on and start measures for early healing. The same strategies which help us prevent ulceration also help us in achieving early healing. They include frequent changes in position (at least two hourly), prevention of maceration of the skin, and ensuring appropriate nutrition. It is recommended to seek the help of a healthcare worker to help guide the treatment of the pressure sore. Neglect of a pressure sore can give rise to major complications such as spreading infection. Those involved in the care of such individuals should be mindful of the possibility of pressure sores and should inspect the sore prone areas daily for skin breakdown.
Pressure sores are graded based on their severity. Milder and early stages involve a breakdown of the skin and underlying fat. More severe grades involve the underlying muscles and bones. Milder cases can usually heal with the help of appropriate nursing care. More severe grades of pressure sores require reconstructive surgery for healing. Surgery is undertaken when the patient is appropriately nourished. Surgery for pressure sores usually involves the use of local flaps. Flaps are tissues with an intact blood supply that is moved to bring in well-vascularized tissue to the area of ulcer. Depending on the location of the ulcer various flaps are used for pressure sore surgery. The patient should be taken care, by a well-motivated nursing team. In India, most of our patients are shifted home after spending a few days at the hospital. They are then taken care of by their relatives with or without the help of health care workers. The benefits of surgery will not be long-lasting in the absence of steps taken to prevent bedsores. The steps for the prevention of sores should be strictly adhered to in the period following surgery.
A healed pressure sore helps both the patient and relatives to better cope with a situation that is already stressful.
Ischial pressure sore
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Post-op after coverage with gluteus myocutaneous flap
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