What are Bedsores?
Bedsores, also known as pressure ulcers or pressure sores, involve damage to the skin and underlying soft tissue due to prolonged pressure (1).
Bedsores are more common on areas that have bones that stick out from the affected area, including the tailbone, ankles, and heels.
Those at the greatest risk of getting bedsores are elderly individuals who have medical problems that prevent their ability to turn themselves in bed or on a wheelchair. Bedsores can develop extremely quickly and can be very difficult to treat. This emphasizes the importance of preventing bedsores rather than treating them with surgery or other methods.
Symptoms of Bedsores
There are various stages of bedsores that differ in their severity (3). According to the National Pressure Ulcer Advisory Panel, the stages of bedsores is as follows:
In stage one disease, the skin is still intact. It usually appears reddened and doesn’t blanch when touched. Bedsores in stage I may be painful, soft, warm, tender, firm or cold when compared to normal skin.
In stage II of bedsores, the epidermis (outer layer) and the dermis are broken open and lost. There may be a shallow wound that is red or pinkish in color, which may resemble a ruptured blister.
Stage III involves having a deep wound that exposes fatty tissue. The ulcer typically resembles a crater with a yellow-colored base of nonviable tissue. The damage may spread to surrounding areas of normal skin.
In this stage of bedsores, there is a great deal of lost tissue that can expose the tendons, muscles or bones. The base of the wound contains dead tissue that is crusty and dark in color, and there is damage extending into healthy tissue.
Typical Sites of Bedsores
If the individual is confined to a wheelchair, the sore usually occurs on the tailbone, buttocks, shoulder blades, the backs of the arms and legs or on the spine.
For patients who are bedridden, the most common sights of bedsores include the sides or back of the head, ears, shoulder blades, heels, ankles, behind the knees, the tailbone, the lower back, or the hip.
Causes of Bedsores
Pressure sores are usually caused by excess pressure of an object against the skin that decreases the flow of blood to the skin. As a result of the pressure, the skin becomes prone to damage.
Contributors to getting a bedsore include the following:
- Ongoing pressure on the skin. The pressure of the skin against an object is greater than the pressure inside the blood vessels in the body so that tissue, particularly skin cells, become damaged and die off. They tend to happen in places on the body that aren’t padded with muscle or fat.
- Friction. This is defined as resistant to motion. The skin may be dragged across the bed during positon changes. The sores tend to develop mostly in places that are moist or that have fragile skin.
- Shear forces. This happens when two different surfaces are caused to move in different directions. If the patient moves around in bed, there can be friction on a body area, resulting in the formation of a bedsore.
Risk Factors Of Bedsores
Those at greatest risk of bedsores are those that cannot easily move about in bed or have to remain in bed or a wheelchair for long periods of time. Causes of a lack of mobility include the following:
- Poor health
- Any injury that requires prolonged bed rest or the use of a wheelchair
- Surgical recovery
Age can play an important role in one’s risk of getting a bedsore. Older individuals are more vulnerable to having skin that is thin, fragile, dry and less elastic when compared to the young. Individuals with spinal cord injuries or other neurological disorders that lack independent mobility can get bedsores if they are not moved frequently.
Those who lose weight during a long-lasting illness will lose the protective fat, making them more prone to bedsores. Those who are dehydrated or have poor nutrition do not have the resources to repair damaged skin. If the skin is excessively moist or too dry, this can increase the friction between bed clothing, the bed and the skin. People with bowel incontinence can get local infections of the buttocks that combine to form infected bedsores.
People with diseases that decrease blood flow to the skin are also more likely to get bedsores. This includes those who are diabetic or who have vascular disease. Smokers are at a higher risk of bedsores, as are people with decreased mental awareness. People with muscle spasms have increased shearing of the skin against the bed and can develop bedsores as a result.
Treatment of Bedsores
People who have stage I and stage II bedsores usually will heal within a few weeks to a few months, depending on how the wound is cared for (2). Those with stage III and stage IV bedsores have a more difficult course of treatment.
The goal of reducing bedsores is to lessen the pressure on the skin. Some tips for reducing the chance of bedsores are:
- Frequent repositioning. Regular repositioning is required to prevent and treat bedsores. For wheelchair-bound individuals, weight must be shifted about every fifteen minutes. Nurses or caretakers should reposition the person every hour. Use a trapeze bar in bed in order to move your body around without having too much friction or shear force.
- Make use of support surfaces. People with bedsores need special beds and mattresses that allow the patient to lie with the least amount of pressure. Cushions should be used for wheelchairs. There are several types of wheelchair cushions that lessen the chance of bedsores.
- Keep the wound clean. It is necessary to prevent infections by keeping any open wounds clean. If the skin has not yet broken, it should be washed with soap and water and kept dry. Open sores require salt water to clean the wound with each dressing change.
- The application of dressings. Various dressings can be used to keep the wound wet and create a barrier between areas of infection and the clean wound. There are a variety of dressings used to treat bedsores.
- Remove damaged tissue. Dead tissue must be removed through surgical debridement. Mechanical debridement can be done to loosen and remove debris in the wound. Low frequency mist ultrasound can remove damaged tissue, and special dressings can be used. Other forms of debridement include autolytic debridement, in which the body uses enzymes to break down non-vital tissue. Enzymatic treatment uses chemical enzymes and special dressings to dissolve dead tissue.
- Surgery. If the sore doesn’t heal by nonsurgical means, then surgery is recommended. Surgery removes dead tissue and repairs the wound with muscle or other connective tissue in order to naturally pad the wound.
- Pressure Ulcers. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed 3/16/2016.
- Berlowitz D. “Treatment of Pressure Ulcers”. http://www.uptodate.com/home. Accessed 3/16/2016.
- AskMayoExpert. Pressure ulcer. Rochester, MN: Mayo Clinic Foundation for Medical Education and Research; 2013.