Bedsores

Encyclopedia of Medicine by Maureen Haggerty

Bedsores are also called decubitus ulcers, pressure ulcers, or pressure sores. These tender or inflamed patches develop when skin covering a weight-bearing part of the body is squeezed between bone and another body part, or a bed, chair, splint, or other hard object.

Each year, about one million people in the United States develop bedsores ranging from mild inflammation to deep wounds that involve muscle and bone. This often painful condition usually starts with shiny red skin that quickly blisters and deteriorates into open sores that can harbor life-threatening infection.

Bedsores are not cancerous or contagious. They are most likely to occur in people who must use wheelchairs or who are confined to bed. In 1992, the federal Agency for Health Care Policy and Research reported that bedsores afflict:

• 10% of hospital patients
• 25% of nursing home residents
• 60% of quadriplegics.

The Agency also noted that 65% of elderly people hospitalized with broken hips develop bedsores and that doctors fees for treatment of bedsores amounted to $2,900 per person.

Bedsores are most apt to develop on the:

• Ankles
• Back of the head
• Heels
• Hips
• Knees
• Lower back
• Shoulder blades
• Spine.

People over the age of 60 are more likely than younger people to develop bedsores. Risk is also increased by:

• Atherosclerosis (hardening of arteries)
• Diabetes or other conditions that make skin more susceptible to infection
• Diminished sensation or lack of feeling
• Heart problems
• Incontinence (inability to control bladder or bowel movements)
• Malnutrition
• Obesity
• Paralysis or immobility
• Poor circulation
• Prolonged bed rest, especially in unsanitary conditions or with wet or wrinkled sheets
• Spinal cord injury.

Bedsores most often develop when constant pressure pinches tiny blood vessels that deliver oxygen and nutrients to the skin. When skin is deprived of oxygen and nutrients for as little as an hour, areas of tissue can die and bedsores can form.

Slight rubbing or friction against the skin can cause minor pressure ulcers. They can also develop when a patient stretches or bends blood vessels by slipping into a different position in a bed or chair.

Urine, feces, or other moisture increases the risk of skin infection, and people who are unable to move or recognize internal cues to shift position have a greater than average risk of developing bedsores.

Other risk factors include:

• Malnutrition
• Anemia (lack of red blood cells)
• Diuse atrophy (muscle loss or weakness from lack of use)
• Infection.

Physical examination, medical history, and patient and caregiver observations are the basis of diagnosis. Special attention must be paid to physical or mental problems, like incontinence or confusion, that could complicate a patient's recovery.

Bedsores usually follow six stages:

• Redness of skin
• Redness, swelling, and possible peeling of outer layer of skin
• Dead skin, draining wound, and exposed layer of fat
• Tissue death through skin and fat, to muscle
• Inner fat and muscle death
• Destruction of bone, bone, infection, fracture, and blood infection.

Prompt medical attention can prevent surface pressure sores from deepening into more serious infections. For mild bedsores, treatment involves relieving pressure, keeping the wound clean and moist, and keeping the area around the ulcer clean and dry. Antiseptics, harsh soaps, and other skin cleansers can damage new tissue, so a saline solution should be used to cleanse the wound whenever a fresh non-stick dressing is applied.

The patient's doctor may prescribe infection-fighting antibiotics, special dressings or drying agents, or lotions or ointments to be applied to the wound in a thin film three or four times a day. Warm whirlpool treatments are sometimes recommended for sores on the arm, hand, foot, or leg.

In a procedure called debriding, a scalpel may be used to remove dead tissue or other debris from the wound. Deep, ulcerated sores that don't respond to other therapy may require skin grafts or plastic surgery.

A doctor should be notified whenever a person:

• Will be bedridden or immobilized for an extended time
• Is very weak or unable to move
• Develops bedsores.

Immediate medical attention is required whenever:

• Skin turns black or becomes inflamed, tender, swollen, or warm to the touch
• The patient develops a fever during treatment
• The sore contains pus or has a foul-smelling discharge.

With proper treatment, bedsores should begin to heal two to four weeks after treatment begins.

Zinc and vitamins A, C, E, and B complex help skin repair injuries and stay healthy, but large doses of vitamins or minerals should never be used without a doctor's approval.

A poultice made of equal parts of powdered slippery elm (Ulmus fulva), marsh mallow (Althaea officinalis), and echinacea (Echinacea spp.) blended with a small amount of hot water can relieve minor inflammation. An infection-fighting rinse can be made by diluting two drops of essential tea tree oil (Melaleuca spp.) in eight ounces of water. An herbal tea made from the calendula (Calendula officinalis) can act as an antiseptic and wound healing agent. Calendula cream can also be used.