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Pressure Ulcer

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 4 minutes read
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Pressure ulcers are also known as bed sores.

They occur due to prolonged pressure on a certain area of the body causing injury or damage to the skin and underlying tissue. They often affect bony areas which have thin layers of tissue overlying them such as the lower spine, heels, hips or elbows. But they can develop anywhere.

As the chances of developing a pressure sore increase the longer the pressure is applied, so the highest risk comes to those confined to a bed or chair for long periods.

Early signs of a pressure ulcer developing are when the area starts to become pink and painful. Later the skin may start to become hardened or warm. If a pressure ulcer is not taken care of at this stage, it can then develop into a break in the skin. Over time this can lead to a wound or blister, that begins to extend into the deeper tissues and finally the muscle. At this stage, it is very painful.

How do I prevent a pressure ulcer?

Ensure that you eat a balanced and nutritious diet, which will ensure that you are not dehydrated or nutritionally deplete and your skin is in the best condition to prevent an ulcer from developing. You can check to see if your skin is hydrated with the skin pinch test. Keep skin clean and dry, and apply emollient moisturisers as necessary, to keep it in good condition.

If you are confined for long periods of time to a chair or bed, it’s important to try and change your position regularly. This might be turning a different angle in bed, and alternating the areas where pressure is applied. If you are not able to do this yourself, you may need to get someone to help.

Provide cushioned support to certain areas which may be at risk, for example, bony points.

Ensure that your skin is checked regularly for any early signs of a pressure ulcer developing.

It is also important to stop smoking, as smoking affects many aspects of wound healing.

Stages of Pressure Ulcers

Pressure ulcers are classified into different stages based on the extent of tissue damage and depth of the wound. The staging system commonly used to categorise pressure ulcers is as follows:

  1. Involves non-blanchable erythema (redness) of intact skin, indicating early tissue damage without open wounds.
  2. Partial-thickness skin loss involving the epidermis and/or dermis (outmost layers of skin). The wound may appear as an abrasion, blister, or shallow crater.
  3. Involves full-thickness skin loss extending into the subcutaneous tissue (deeper skin layers), resulting in a deep crater with visible fat tissue.
  4. Represents the most severe stage, with full-thickness skin loss and extensive tissue damage involving muscle, bone, or supporting structures.

Sometimes, when the extent of tissue damage is obscured by eschar (dry, black, necrotic tissue) or slough (yellow, fibrinous tissue), it is difficult to assess the depth of the wound.

Treatment of Pressure Ulcers

The management of pressure ulcers involves a multidisciplinary approach tailored to the specific needs of the individual and the severity of the wound. Treatment strategies may include:

Wound debridement - removing dead tissue, slough, and debris from the wound bed to promote healing and prevent infection

Dressings - Apply appropriate wound dressings such as hydrocolloids, foams, alginates, or films to maintain a moist wound environment, absorb exudate, and protect the wound from further trauma.

Pressure relief - offloading pressure from the affected area using specialized devices, cushions, or positioning techniques to minimise further tissue damage and facilitate healing.

Nutritional support - optimising nutritional status with adequate protein intake, hydration, and micronutrient supplementation to support tissue repair and regeneration. You may need support from a nutritionist.

Pain management - addressing pain and discomfort associated with pressure ulcers through painkillers, topical treatments, or methods such as positioning and supportive care.

Surgical interventions - in the worst case or when conservative measures are ineffective, surgical interventions such as skin grafting, flap reconstruction, or tissue transfer may be considered to promote wound closure and tissue regeneration.

When should I see my doctor?

If you are under constant care, such as a care home or hospital, they should be regularly monitoring for the development of any pressure ulcers. If you or someone else notices areas of concern, it’s important to tell your health professionals straight away, as it’s not usually something that gets better with time.

Even with constant monitoring and good care, pressure ulcers can still develop and that can be because in some people their skin breaks down very quickly.

How are pressure ulcers treated?

Pressure ulcers can be managed at home if they are not very severe. This can be through dressings and creams, regular turning in your position and using support appliances such as mattresses and cushions to reduce the pressure.

If there is a significant breakdown in the tissue the wound may need to be cleaned and dead tissue removed, in order to aid better healing.

If the ulcer is very severe and has caused an infection, this may require antibiotics – either at home or in hospital, depending on how unwell you are.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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