Pressure ulcers

Pressure ulcers, also known as bedsores or decubitus ulcers, are localized damage to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. They often occur on skin that covers bony areas of the body, such as the heels, ankles, hips, and tailbone. People most at risk of pressure ulcers are those with a medical condition that limits their ability to change positions or those who spend most of their time in a bed or chair.

Causes and Risk Factors

Pressure ulcers are caused by three main factors: pressure, shear, and friction. Pressure is the primary cause and occurs when the skin and underlying tissues are caught between a bone and an external surface, such as a bed or wheelchair. Shear is a force that acts against the skin while the skin remains stationary and the bone moves. Friction occurs when the skin rubs against an external surface. Other risk factors include immobility, incontinence, poor nutrition, and decreased mental awareness.

Stages of Pressure Ulcers

Pressure ulcers are classified into four stages based on their severity:

• Stage I: The earliest stage, characterized by non-blanchable redness of intact skin.
• Stage II: Partial-thickness skin loss with exposed dermis.
• Stage III: Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue.
• Stage IV: Full-thickness skin and tissue loss with exposed bone, tendon, or muscle.

Unstageable ulcers, where the base of the ulcer is covered by slough (dead tissue) and/or eschar (black or brown necrotic tissue), and suspected deep tissue injury, where the area over the bone feels mushy or boggy, are also recognized.

Prevention and Management

Prevention and management of pressure ulcers involve regular skin inspections, maintaining good nutrition and hydration, repositioning at least every two hours to relieve pressure, using support surfaces like special mattresses or cushions, and keeping the skin clean and dry. Treatment depends on the stage of the ulcer and includes cleaning and dressing the wound, removing dead tissue, and possibly surgery.

Complications

Complications of pressure ulcers include infections, sepsis, chronic pain, and an increased risk of cancer in chronic wounds. They can also lead to prolonged hospital stays and increased healthcare costs.

Conclusion

Pressure ulcers are a significant and preventable health issue, particularly among the elderly and those with conditions that limit mobility. Early detection, appropriate management, and preventive measures are crucial in reducing the incidence and severity of these injuries.