Bedsores: prevention and treatment

To treat them, targeted treatment is required depending on the severity of the injury.

A pressure lesion is defined as a pathological state of the skin, and possibly also of the underlying tissues, which arises in an area of the body subject to chronic compression.

The circumstance that most commonly determines the establishment of lesions of this type is, precisely, the maintenance of the lying position (decubitus) for prolonged periods, but any situation that involves a stable compression on a skin area can be at the origin of a pressure sorrow.

Where they can locate themselves

As it is easy to guess, the areas of the body most predisposed to the development of pressure sores are those corresponding to bony prominences:

  • the sacrum, posterior protrusions of the vertebrae, shoulder blades, occipital bone (nape) and heels in the supine position
  • the upper end of the femur, the lateral protrusion of the hip, the internal and external malleoli, the outer edge of the foot, the knee, shoulder and elbow joints and the auricle in the lateral position
  • the bones of the cheekbone and temple, the auricle, the ribs, the anterior protrusion of the hip in the prone position
  • the tailbone, the lower hip protrusions, the elbow joint, the back of the knee joint in the sitting position.

Why they are formed

The first mechanism that underlies the development of a pressure injury is the alteration of blood circulation within the compressed tissues: skin, subcutaneous tissues, muscles.

To aggravate the tissue damage may be added the friction or traction of the skin against the support surfaces (for example clothing, bed linen, armrests, headrests and wheelchair support bands) or the humidity that can be created by lack of ventilation of the affected area (for example inside diapers, bandages, casts, supports for immobilization).

Risk factors

The most important risk factor is the drastic reduction in mobility that can be determined when bedridden or wheelchair bound or when a part of the body is immobilized for a long period of time.

Other conditions that, in the presence of compression, further promote skin damage are:

  • advanced age, due to changes in subcutaneous tissue, lower efficiency of peripheral circulation and frequent nutritional deficiencies
  • excessive thinness, due to the scarcity of adipose tissue
  • severe obesity, due to microcirculation impairment and movement difficulties
  • the presence of metabolic disorders (such as diabetes) or circulatory disorders (venous insufficiency), due to the alteration of the healing processes of skin lesions
  • malnutrition, due to the lack of essential macronutrients (especially proteins) and micronutrients (vitamins and minerals)
  • exposure to irritants or infectious substances (urine, faeces).

How to treat them and how to avoid them

The treatment of injuries requires professional intervention (generally provided by competent nursing staff), which involves specific cleansing and dressing procedures and which must be adapted to the level of severity of the injury.

The latter is defined on the basis of a classification system (among the most used internationally is that of the National Pressure Ulcer Advisory Panel), which takes into account the depth of the lesion, and therefore the involvement of the tissues underlying the skin.

Damage that initially affects only the skin plane with simple redness (stage I) can, if not treated promptly, extend progressively, with abrasion of the epidermis (stage II) and subsequent destruction of the subcutaneous tissue (stage III) and deeper ones (muscles, tendons, bones) (stage IV).

In addition to the local treatment of the lesions, it is always essential to correct the conditions that determine the compression, through the positioning of anti-decubitus mattresses / pillows and protections for bone prominences (heels, elbow pads, etc.) in suitable material, and above all through the frequent mobilization (every 1-2 hours in bed, every 15-30 minutes in the chair) of the subject.

No less important measures are the careful hygiene of risk areas, where the skin must be kept clean and dry, and the possible integration of nutrients as part of a diet that is as varied as possible and rich in vitamins, minerals and antioxidants.

The same measures – relating to the cleaning and aeration of the skin, nutrition, the lightening of localized compressions with the appropriate health devices and regular mobilization – are also of fundamental importance to prevent the development of pressure sores in predisposed subjects due to difficulty or impossibility of movement and / or general health conditions.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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