Pressure ulcers are prolonged immobilization wounds, whether sitting or lying down. They appear on areas of pressure such as buttocks or heels.
A bedsore, what is it?
Definition of a pressure ulcer
A pressure ulcer is a localized zone of ischemia (lack of oxygen) causing pain in the skin and subcutaneous tissues, caused by pressure, shearing and / or rubbing of the skin. It begins with a redness that does not fade when pressed against the skin and evolves into a wound that can go to the bone
The different types of pressure ulcers
There are four stages in the evolution of pressure ulcers:
Stage 1: Redness does not whiten with the pressure, on a constant zone of support (buttock, heel …). From this stage there may be a destruction of the subcutaneous tissues, especially the muscles, much more sensitive to hypoxia than the skin.
Stage 2: Superficial wound of the skin with abrasion type or simple bubble
Stage 3: Deep wounds of the skin affecting the epidermis, dermis and subcutaneous tissues but not affecting the underlying muscles
Stage 4: Wound up to muscle or bone.
Causes of pressure ulcers
The pressure ulcer is related to the constant pressure, even the shear and / or a chronic rubbing of the skin, causing a decrease in vascularization (ischemia) and therefore tissue oxygenation. The muscles are more sensitive to ischemia than the skin, so an incipient eschar without cutaneous wound can already have underlying muscle lesions.
Which people are most at risk of developing a pressure ulcer?
People at risk are people who are immobilized or bedridden such as hospitalized and bedridden patients, wheelchair paraplegic patients …
The diagnosis of pressure ulcers
The diagnosis of the eschar is made during the regular observation of the skin by the health care team, particularly with regard to the bony prominences, by the discovery of a simple persistent redness of the skin does not fade when press on it. This is stage 1 of the eschar. Unfortunately, sometimes the diagnosis is later, especially in people in wheelchairs who have lost all sensitivity (paraplegia …) by the discovery of a wound formed on a “hidden” area: lower back, buttock …
Evolution and possible complications
Even a stage 1 eschar may have underlying muscle damage. We must never neglect pressure ulcers. They are likely to evolve in the following stages rather quickly in the absence of adequate treatment. The main complications of the eschar are:
- the pain in people who still skin sensitivity
- The superinfection of the wound and the underlying noble tissues (osteomyelitis)
- the absence of healing despite adequate treatment
The symptoms of pressure ulcers
How to recognize the appearance of an eschar?
The appearance of an eschar is characterized by a simple persistent redness of the skin does not fade when pressed . This is stage 1 of the eschar.
The risk factors for pressure ulcer are:
- the immobilization of a patient chair or bed , causing a constant pressure on the skin, even shearing of the skin and / or chronic rubbing against the bony prominence areas: sacrum, buttock, hips, ankles, elbows, posterior part of the skull in contact with the bed …
- lack of equipment to reduce the risk of pressure ulcers: beds or anti-eschar chair, cushions limiting prolonged support or wedges of moss avoiding direct contact of the bony prominence between them (knees, heels or ankles …)
- no change in the regular position of a patient (if his state of health permits)
- absence or decrease in sensitivity to a patient’s pain
- lack of proper positioning and transfer techniques of an immobilized patient, aimed at limiting friction and shearing of the skin
- areas of excessive moisture related to incontinence, sweating or wound exudates
- malnutrition or cachectic state
- lack of physiotherapy and rehabilitation for recovery of autonomy and walking, when the patient’s state of health improves
The expert opinion
Pressure ulcers are among the most difficult to treat skin wounds because risk factors are often difficult to avoid: constant pressure on the wound due to immobilization, patients in poor general condition and / or malnourished with sudden onset of healing, patients having lost their sensitivity to pain (paraplegia, coma …) and being unable to report an aggravation …
In hospitals, there are also fears of the appearance of a nosocomial infection multidrug-resistant beds eschar.
Prevention of bedsores is very important!