A pressure sore is a nutritional disorder of the skin and subcutaneous tissue. It results from prolonged exposure to pressure and compression of blood vessels. Eventually, skin death and infection may occur. Often bedridden people are affected, but there are other causes.
Causes of pressure sores
Most commonly, pressure sores occur when people are bedridden. Pressure sores are most likely to occur on parts of the body where there is no or little muscle between the skin and the underlying bones. The main areas to be mentioned are:
- Heels
- Ankle
- Pelvic crests
- Coccyx
- Back of the head
- Pelvic scoops
Ultimately, however, a pressure sore can occur in any location. A pressure sore can also occur under ill-fitting prostheses or too tight plaster casts.
Important factors in the development of a pressure ulcer
Three factors play a critical role in pressure ulcer development:
- Pressure (contact pressure)
- Time (print dwell time)
- Disposition (risk factors)
Only when a certain pressure exists for a long time (two hours) with an existing disposition of the patient, damage to the skin occurs. One factor by itself does not lead to pressure ulcer.
1. pressure
Blood flow to the skin capillaries, the finest blood vessels that provide oxygen and nutrients to each organ, is impeded once the pressure on the capillaries exceeds a certain level. The pressure on the skin can be exerted from the outside or from the inside:
- Pressure from the outside: for example, folds in the bed sheet, unpadded positioning splints, crumbs in the bed, and also catheters and probes when they are placed under the patient.
- Pressure from within: Due to bones that lie directly under the skin without muscle and fat padding.
2. time
What matters is how long the pressure is on certain areas of the skin. If the nutrition of skin cells was interrupted for less than two hours, they can recover. If the lack of oxygen is prolonged, individual cells die, and necrosis (tissue death) forms.
3. disposition
For example, the skin is damaged by:
- Fever: sweating causes dehydration of the body and increased oxygen consumption.
- Moisture: Moist skin softens and is therefore more vulnerable
- Incontinence: In incontinent patients, the skin is stressed not only by moisture, but additionally by the acidic pH of urine and possibly by bacterial contamination (intestinal bacteria)
- Overweight: Fat patients usually sweat more, at the same time the weight bearing on the skin is greater
- Shear forces: the “inclined plane” when sitting incorrectly tugs at the skin
The skin is poorly supplied with blood at:
- Anemia and cardiac insufficiency, which favor a deficiency of blood flow.
- Diabetes mellitus: here, in addition to blood circulation, cell metabolism is also disturbed
Risk factors for a pressure ulcer
Pressure relief is hindered by lack of movement (immobility), bed rest (such as unconsciousness), paralysis such as hemiplegia, and therapeutic immobilization (plaster cast). Other risk factors include:
- Weakness of the body’s defenses due to inadequate nutrition (for example, lack of protein, zinc or vitamin C).
- Poor general condition
- Cachexia (emaciation)
- Chronic diseases leading to fluid loss and atrophy of the skin.
Course of a pressure ulcer
In the course, four degrees of severity of pressure ulcers are distinguished:
- In a decubitus of the first degree, you can see only a circumscribed redness of the skin.
- In the second degree, a skin defect has already occurred.
- In a third-degree pressure ulcer is a deep skin defect, muscles, tendons and ligaments are visible.
- In the worst form, there is a defect with bone involvement.
Complications of a pressure ulcer
An aggravating factor may be infection of the wound. If the tissue dies, it must be surgically removed.
Treatment of a pressure ulcer
If a pressure sore needs to be treated, it is usually already too late. Prevention is very important, so that a pressure ulcer does not occur in the first place.The skin of bedridden patients in particular should be well cared for. Rubbing with ointments that promote circulation and massaging the areas at risk can prevent pressure sores from occurring in the first place. In addition, care should be taken to ensure soft positioning, possibly on special mattresses. Good nursing care also includes repositioning the patient every two hours. This is done according to a positioning plan: Supine position, right lateral position, possibly prone position, left lateral position, supine position, etc. At the first signs of a pressure sore (reddening of the skin), good skin care is already the appropriate therapy. Open wounds must be carefully cleaned. Anti-inflammatory and healing-promoting ointments are applied to the wound surface. If there is no improvement in the symptoms of the disease after three to four days, the medication should be changed. If the skin and surrounding tissue is already dead, it must be surgically removed.
