Bed sores are also called pressure ulcers. They occur when the skin and underlying tissue are damaged. In very severe cases the muscle and bone can also be injured.
People who cannot move all or part of their body due to illness, paralysis, or advanced age often suffer from these pressure sores.
Are bedsores common?
Bed sores are a widespread and often overlooked health problem. For example, in India it is believed that between 4% and 10% of all patients admitted to hospital will develop at least one pressure ulcer. In the cases of elderly people with mobility problems, the figure shoots up to 70%.
Even with the best medical and supportive care, pressure ulcers can be difficult to prevent in particularly vulnerable patients.
In some cases bedsores are a minor inconvenience and can be treated simply. However, they can sometimes cause extensive skin damage and lead to serious infections such as sepsis, or general and widespread infection of the blood, or gangrene, death of body tissue.
There are two main objectives when assisting patients at risk of developing bedsores. These are:
- Try to prevent bed sores from developing by wearing special clothing and equipment and by frequently changing the position of the patient.
- Treat existing bed sores through proper cleaning and the use of antibiotics, improving eating habits and, in the most severe cases, surgery.
The areas most exposed to bed sores are the parts of the body that are not covered by a significant amount of body fat and are in direct contact with a support surface such as a bed or wheelchair.
For example, a convalescent bedridden patient is at risk of developing a pressure ulcer in:
- shoulders or upper back
- the elbows
- the neck
- the edge of the ears
- knees, ankles, heels, or toes
- lower back and hips
- the genitals (in men), and
- the breasts (in women).
A wheelchair user is at risk of developing a pressure ulcer in:
- the tailbone (the end of the spine)
- spinal column
- shoulder blades, and
- the back of arms and legs
Degrees of bedsores
Healthcare professionals use a classification system to describe the severity of pressure ulcers. The grades are described below:
A first-degree eschar is the most superficial type of ulcer. The affected skin area appears discolored and reddish in white patients and bruised or bluish in patients with darker skin. In a first-degree pressure ulcer, the skin remains intact, but it can be painful, itchy, and either warm and fluffy or hard to the touch.
In second-degree pressure ulcers, part of the outer surface of the skin (the epidermis) or the innermost part of the skin (dermis) is damaged, causing a loss of skin tissue.
The ulcer appears as an open wound or blister.
In a third-degree pressure ulcer, the loss of skin occurs throughout the thickness of the skin and the underlying tissue is also damaged. Muscles and bone are undamaged.
The ulcer looks like a deep, hollow wound.
A fourth degree eschar is the most serious type of ulcer. The skin is severely damaged and the surrounding tissue dies (necrosis). The underlying muscle, or bone, can also be damaged.
Patients with fourth-degree bedsores are at high risk of developing serious infections.
Change of position
Moving the body and changing position at regular intervals is one of the best ways to prevent bedsores and to relieve pressure in first- and second-degree ulcers.
Once the risk assessment is completed, the healthcare team will develop a “repositioning schedule” that will show how often the patient should be moved. For some patients, the frequency may be 15 minutes, while others will only need a position change every two hours.
- A nurse or therapist can also provide advice and training on:
- correct positions when lying down or sitting down
- correct ways to adjust the position when lying down or sitting down
- how often the patient should be moved
- best way to support your feet
- how to maintain good posture, and
- the specialized equipment to use and how to use it correctly.
Mattresses and cushions
A range of special mattresses and cushions to relieve pressure on vulnerable parts of the body is at your disposal. Your healthcare team will be able to determine which types of mattresses or cushions are best for you.
People who are considered at risk of developing bedsores, or who have existing first- or second-degree bedsores typically benefit from resting on specially designed foam mattresses to relieve pressure on their body.
Patients with third or fourth degree bedsores need a more sophisticated mattress or even a bed system. For example, there are mattresses that can be connected to a continuous flow of air, which is automatically regulated to reduce pressure when necessary.
Some special dressings and bandages, designed to protect pressure ulcers and speed up the healing process, are also available in our range of products.
Some examples of this type of product are:
- Hydrocolloids, dressings that contain a special gel that encourages the growth of new skin cells in the ulcer while keeping the healthy skin in the area dry, and
- Alginates, dressings made from seaweed that contain sodium and calcium and have been shown to speed up the healing process.
Topical preparations such as creams or ointments can be used to speed up the healing process while preventing further skin damage. A class of chemicals known as oxygen free radical scavengers can also be used to prevent cell damage at the genetic level.
If a patient suffers from bed sores, they may be given antibiotics to prevent bacterial infection and, as a precaution, to also prevent the development of a secondary infection.
The antiseptic ointment can also be applied directly to the bed sores to cleanse them of any bacteria present.
Some dietary supplements such as protein, zinc, and vitamin C have been shown to accelerate wound healing. If your diet is lacking in these vitamins and minerals, your skin can be vulnerable to developing pressure sores.
As a result, you can be referred to a dietitian to develop a proper nutritional plan.
In some cases, it may be necessary to remove the necrotic tissue from the ulcer to stimulate the healing process. This is known as debridement.
If there is a small part of dead tissue, it can be removed by using special dressings and creams.
Large amounts of dead tissue can be removed mechanically. Some of the mechanical debridement techniques are:
- pressure cleaning and irrigation – in which necrotic tissue is removed with pressurized water
- ultrasound – in which dead tissue is removed with low-frequency energy waves, and
- laser – in which dead tissue is removed with beams of concentrated light.
Sometimes a third or fourth degree ulcer cannot heal and surgery is needed to seal the wound and prevent further tissue damage.
A commonly used surgical technique for bed sores treatment in Delhi is called graft replacement (sometimes also called graft reconstruction). In this technique, the plastic surgeon in Delhi uses a scalpel to debride the ulcer of necrotic tissue. A skin and muscle graft is taken from another part of the body and used to seal the ulcer.
Graft surgery is complicated in itself and can be very challenging because patients who need it are already in poor health. As a result of these risk factors, there are a large number of possible complications that can result from surgery, including:
- tissue death in the graft,
- muscular weakness,
- reappearance of bedsores,
- blood infection,
- bone infection
- internal bleeding,
- abscesses and
- Deep venous thrombosis.
Despite the high risk of complications, surgery is a frequent clinical necessity to prevent life-threatening effects of bedsores, such as septicemia or gangrene.