Bedsore

Bedsore

Bedsore, also known as pressure ulcer or decubitus ulcer, is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. These ulcers are a significant concern in healthcare settings, particularly for individuals with limited mobility.

Pathophysiology

Pressure ulcers occur when there is prolonged pressure on the skin, which impairs blood flow to the affected area. This lack of blood flow can lead to tissue ischemia and necrosis. Common sites for bedsores include the sacrum, heels, elbows, and hips. The risk of developing pressure ulcers increases with immobility, poor nutrition, and moisture.

Staging

Pressure ulcers are classified into four stages based on the depth of tissue damage:

• Stage I: Non-blanchable erythema of intact skin. The area may be painful, firm, soft, warmer, or cooler compared to adjacent tissue.
• Stage II: Partial-thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
• Stage III: Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
• Stage IV: Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed.

Risk Factors

Several factors increase the risk of developing pressure ulcers, including:

• Immobility due to illness, injury, or sedation
• Poor nutrition and hydration
• Advanced age
• Neurological conditions that impair sensation
• Incontinence leading to skin moisture
• Medical conditions affecting blood flow, such as diabetes and vascular disease

Prevention

Preventing pressure ulcers involves a combination of strategies:

• Regular repositioning to alleviate pressure
• Use of support surfaces such as specialized mattresses and cushions
• Maintaining good skin hygiene and moisture control
• Ensuring adequate nutrition and hydration
• Conducting regular skin assessments, especially in high-risk patients

Treatment

The treatment of pressure ulcers depends on the stage and severity of the ulcer:

• Stage I and II: Relieve pressure, protect the area with dressings, and maintain skin hygiene.
• Stage III and IV: More intensive treatment is required, including debridement of necrotic tissue, advanced wound dressings, and possibly surgical intervention.

Complications

If not properly managed, pressure ulcers can lead to serious complications such as:

• Infection, including cellulitis, osteomyelitis, and sepsis
• Chronic pain
• Prolonged hospital stays and increased healthcare costs

See Also

• Wound healing
• Skin care
• Geriatric medicine

References

• National Pressure Ulcer Advisory Panel (NPUAP) guidelines
• European Pressure Ulcer Advisory Panel (EPUAP) guidelines

External Links

• National Pressure Ulcer Advisory Panel
• European Pressure Ulcer Advisory Panel