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 a 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. People over the ageof 60 are more likely than younger people to develop bedsores. Risk is alsoincreased by atherosclerosis (hardening of arteries), diabetes, diminished sensation or lack of feeling, heart problems, inability to control bladder or bowel movements, malnutrition, obesity, paralysis, poor circulation, prolongedbed rest (especially in unsanitary conditions) and spinal cord injury.
Bedsores most often develop when constant pressure pinches tiny blood vesselsthat 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 increase the risk of skin infection, and people who are unable to move or recognize internal cues to shift position have a greater than average riskof developing bedsores.
Bedsores are usually recognized by physical examination., medical history, and patient and caregiver observations. They 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 keeping the area around the ulcer cleanand dry. The patient's doctor may prescribe infection-fighting antibiotics,special dressings or drying agents, or lotions or ointments to be applied tothe wound. Warm whirlpool treatments are sometimes recommended for sores on the arm, hand, foot, or leg.
For more serious bedsores, a procedure called debriding uses a scalpel may beused to remove dead tissue or other debris from the wound. Deep, ulcerated sores that do not respond to other therapy may require skin grafts or plasticsurgery.
Immediate medical attention is required whenever the skin turns black or becomes inflamed, tender, swollen, or warm to the touch, the patient develops a fever during treatment, or the sore contains pus or has a foul-smelling discharge. With proper treatment, bedsores begin to heal two to four weeks after treatment starts.
To prevent bedsores, the patient should be inspected regularly. A bedridden patient should be repositioned at least once every two hours while awake. A person who uses a wheelchair should shift his weight every 10 or 15 minutes, orbe helped to reposition himself at least once an hour. It is important to lift, rather than drag, a person being repositioned, since dragging may aggravate the sores.
If the patient is bedridden, sensitive body parts can be protected by sheepskin pads, special cushions placed on top of a mattress, a water-filled mattress, or a variable-pressure mattress whose sections can be individually inflated or deflated to redistribute pressure.
Bedsores can usually be cured, but can be slow to heal. Without proper treatment, they can lead to infections that slow the healing process, increase thecost of treatment, lengthen hospital or nursing home stays, or cause death. About 60,000 deaths a year are attributed to complications caused by bedsores.