Pressure Sore Management
What is a Pressure Sore?
Pressure sores — also called bedsores or pressure ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Pressure sores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.
Who is at Risk for Developing a Pressure Sore?
People most at risk of pressure sores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for a long period of time. Other conditions such as poor nutrition can also increase the chances of developing a pressure sore.
What are the Most Common Areas Where Pressure Sores Develop on the Body?
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hips, lower back or tailbone
- Heels, ankles and skin behind the knees
Are There Different Severities of Pressure Sores?
Pressure sores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:
- Stage I: The beginning stage of a pressure sore is where the skin is not broken, but appears discolored.
- Stage II: The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- Stage III: The sore is a deep wound where the skin is lost with exposed fat and appears crater-like.
- Stage IV: The sore shows large-scale loss of tissue with possible exposed muscle, bone or tendons often with dead tissue at the bottom.
When Does Someone With a Pressure Sore Need to See a Doctor?
These are the criteria for patients: If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as fever, drainage or a foul odor from a sore, or increased heat and redness in the surrounding skin.
Are there Specific Risk Factors for Developing Pressure Sores?
People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to: generally poor health or weakness, paralysis, injury or illness that requires bed rest or wheelchair use, recovery after surgery, sedation, or coma. Other factors that increase the risk of pressure sores include: advanced age, lack of sensory perception, extreme weight loss, poor nutrition and hydration, excess moisture or dryness, bowel incontinence, poor blood flow, smoking, and muscle spasms.
Can Pressure Sores be Prevented?
Pressure sores are a difficult problem and many can be prevented. Using specialty beds and wheelchairs can decrease the probability of developing a wound. If open wounds occur, surgical treatment using flap surgery may be necessary.
How are Pressure Sores Treated?
In order to give the patient the best chance of healing, it is important to avoid the things that can contribute to the development of pressure sores. Improving nutrition, avoiding pressure on the area, keeping the area clean and treating contractures and spasm can often allow the wound to heal without surgery. Many patients elect to have a wound surgically closed to speed the recovery process. Hyperbaric (or high pressure oxygen) may be used as well.
Pressure sores can develop quickly and are often difficult to treat. Several things can help prevent some pressure sores and help with healing.
What is the Recovery Time from Surgery?
The surgery is usually very well tolerated and may be done on an outpatient basis in select patients. Often, a patient will go to a rehabilitation facility after surgery in order to minimize the risk of recurrence and to get help with the post-operative care.
How Does a Person Determine if He/She is a Surgical Candidate?
The main factor that helps the doctor determine if someone is a surgical candidate is the risk of recurrence. If the risk of recurrence can be reduced and the person is healthy enough to undergo surgery, he/she may be a surgical candidate.
For most patients, an in-office or in-hospital consultation with a physician is required. If patients are unable to travel, alternate arrangements may be made.