Bedsores , also called pressure ulcers, or simply sores, are one of the main hospital complications and therefore one of the most important aspects to be taken into account in all patients confined to bed for long periods
. We are referring above all to the elderly but also to those who for various reasons are forced to spend a period of their time in bed.
Bedsores are pressure sores , therefore tissue alterations that are localized in the areas on which the weight of the body relies in bedridden patients. Therefore the areas most subject to the problem are the shoulders, elbows, forearms, buttocks, calves and heels. The sacral woundsthey are those that have a higher incidence of appearance, especially for patients who are in wheelchairs, as the sacrum bears almost the entire body weight.
These areas, in fact, are subject to continuous stress because they are subjected to the load of body weight and at the same time to compression against the support surface (mattress, chair, wheelchair), with the result of giving rise to alterations in blood circulation .
Bedsores: Photo showing the formation and severity of the process
In these areas the blood pressure tends to increase, creating a stasis, i.e. a phenomenon whereby the circulation slows down and does not allow adequate oxygenation and trophism (supply of nutrients for the tissues), with the result of favoring the formation of clots and result in processes of necrosis, i.e. tissue death.
The sores initially affect the superficial tissues, then the skin (divided into epidermis and dermis), and then gradually affect the subcutaneous and deeper tissues, including muscles, tendons, ligaments, cartilages and bones, and if not properly treated can lead to death from septicemia of the patient.
What are the categories of patients most prone to pressure sores
We have seen how this type of injury is caused by the prolonged stay of patients in lying or sitting positions, therefore the greater risk of onset of pressure sores and immobility.
It goes without saying that the subjects most exposed to this phenomenon are long-term patients, disabled people, patients in coma, women with high-risk pregnancies, who require lying down for most of their gestation, the obese, too. they are forced to remain in static positions for a long time and it must also be taken into account that in this particular group of patients the pressure on the tissues is really excessive.Pressure sores
also form in patients bedridden following multiple bad fractures and in patients suffering from disabling neurological diseases (multiple sclerosis and amyotrophic lateral sclerosis or ALS) .
How do pressure sores present themselves
?formation of pressure sores proceed in distinct phases as we have seen in the images on the previous page.
Initially they manifest themselves as a simple redness (or erythema) localized on the skin of the areas subjected to prolonged compression, subsequently the skin gradually becomes keratinized, thickened and hard to the touch.
The skin alteration proceeds degenerating into vesicles and then into real skin wounds with bleeding, crusting and exposure of the subcutaneous tissues. Gradually the sore extends both in width, expanding more and more, and in depth, affecting the muscle, cartilage, tendon, ligament and even bone tissues.
These phenomena are accompanied by numerous infections and consequent processes of necrosis, ie death of the tissues, which in the most serious cases lead to the death of the subject.
How to do a good wound dressing
In case of compression injuries, or pressure ulcers, we need to talk about prevention rather than cure. In fact, the greatest attention must be placed on preventing the problem from occurring, this because, as seen, these are lesions that are difficult to treat and which constitute a concrete risk factor for the life of patients forced in the same position for long periods. periods.
The bedsoreand a wound that does not heal on its own, in fact tends to become chronic and worsen, therefore it is clear how important it is to follow the right prevention.
What are the tools to prevent the formation of pressure sores
? at regular intervals they perform maneuvers to burden the weight of the patient’s body gradually in different positions.
Every 4-6 hours the subject is moved and placed in different positions, also changing the inclination of the torso and legs to facilitate blood circulation. For the same purpose, superficial skin massages are also performed to improve skin circulation and prevent circulatory stasis.
Furthermore, in the wards where a long hospitalization is planned, specific devices are provided, such as mattresses, pillows and aids to counteract the phenomenon, which have the purpose of preventing excessive compression of the parts of the body that rest on the surfaces and onto which the body weight.
Once the patient is discharged and entrusted to hospitalization at home, the family members or auxiliary staff who will take care of the subject are instructed on the correct rules to follow in order to prevent the formation of pressure sores which, remember, are a an important factor in aggravating the patient’s health conditions.
It is therefore recommended to scrupulously follow all the indications without improvising anything based on your personal beliefs, nor to rely on any advice regarding improbable remedies that have no scientific value.
As reiterated the bedsoresthey can even lead to death and therefore require adequate treatment. Below you will find the guidelines on prevention updated and published on the official website of Mayoclinic.org :
- It is certainly important to change the position of the subject every 4-6 hours, as we have seen previously, to prevent the supporting tissues from being subjected to continuous compressions, and therefore reduce the stasis of circulation and the formation of clots that initiate to the problem;
- Lifting yourself up, if possible, helps to reactivate the circulation. It is enough to lift the torso, the arms or the body by levering on the armrests of the chair or the bed brackets;
- Cleanliness is another crucial factor in limiting the problem as much as possible . The skin should be cleaned on a regular basis, as well as making sure that the sheets or padding of the wheelchair or mobile devices are clean. The skin should be cleansed and washed and talcum powder should be applied to reduce moisture. Furthermore, it is advisable to use smooth underwear that does not have particular seams that can exert pressure on the skin;
- Nutrition plays an important role, in fact it must be taken into account that an immobilized or bedridden patient does not have the same caloric needs as a person free to move. It is not necessary to burden the tissues with an additional load of weight, an event that would favor the onset of the sores. The diet must therefore be limited and weighted on the real metabolic needs of the subject, favoring a diet rich in fruit and vegetables, because on the one hand it keeps the patient hydrated and on the other hand supplies him with precious nutrients, therefore vitamins and mineral salts. It may be useful for this purpose to take food supplements based on zinc and vitamin C to strengthen the immune system and reduce the risk of infections;
- Maintain proper hydration to avoid dehydration. The typical signs of failure to take the right quantities of water are: dark urine , dry mouth, thirst and constipation;
- Another important issue is the use of special medical devices to counter the formation of sores, patients who require a long bed rest need specific mattresses, pillows, dressings and bandages.
When, on the other hand, the sores have already manifested, it is necessary to immediately inform the treating doctor, because the sooner the pressure ulcers are treated , the more effective the therapies will be. It is also remembered that the sores develop in depth, therefore it is a condition that requires the utmost seriousness of intervention.
The therapies are related to the extent of the lesion, generally using local (topical) drugs that have the function of disinfecting the wounds, breaking down the bacterial load and promoting tissue repair and healing. For this purpose it is possible to use a common disinfectant, better based on iodine, available in pharmacies.
Furthermore, it must always be taken into account that the bedsores, if already formed, are subjected to compression again and will again manifest themselves and become chronic. Understandably, these lesions, if the patient is conscious, are very painful therefore it is not uncommon for the doctor to deem it necessary to administer painkillers, non-steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics such as lidocaine in addition to the administration of an antibiotic in case of infections. bacterial.