Causes And Prevention Of Pressure Sores

Causes And Prevention Of Pressure Sores

Discuss briefly pressure sores.
Or
Discuss briefly bed (pressure) sores.

Answer: It is also known as decubitus ulcer pressure sores or Bedsores.

Pressure Sore Pathophysiology

Pressure sore occurs due to compression of issues by an external force.

Blood flow to the skin stops as external pressure becomes more than 30mm of Hg which causes ischemia. Ischemia causes inflammation and tissue anoxia.

Tissue anoxia leads to cell death, necrosis, and ulceration.

Pressure Sore Clinical Features

• It is a trophic ulcer with bone as a base.
• It is a non-mobile, deep, punched-out ulcer.
• It is commonly seen in old age bedridden patients, tetanus, orthopedic
• Patients, diabetics, and patients with head injuries.

Pressure Sore Sites affected

• Over the ischial tuberosity
• Sacrum
• In the heel
• About the head of the metatarsal
• Buttocks
• Over the shoulder
• Occiput

Pressure Sore Factors Causing Pressure Sore

• Normal stimulus to relieve pressure is absent in anesthetized patients.
• Nutritional deficiencies worsen necrosis
• Inadequate padding over bony prominences in malnourished patients
• Urinary incontinence in paraplegia patients causes skin soiling—maceration—infection—necrosis.

Pressure Sore Staging of Pressure Sore

• Non-blanching erythema—Early superficial ulcer
• Partial thickness skin loss—Late superficial ulcer
• Full-thickness skin loss extending into subcutaneous tissue but not through fascia—Early deep ulcer
• Full-thickness skin loss with fascia and underlying structures like muscle, tendon, bone, etc—Late deep ulcer

Pressure Sore Treatment

• The cause for pressure sore should be treated.
• Adequate nutritional supplementation should be done.
• Proper rest, antibiotics, slough excision, and regular dressings should be given.
• Vacuum-assisted closure: It is the creation of intermittent negative pressure of minus 125 mm Hg to promote the formation of healthy granulation tissue.
• • Negative pressure reduces tissue edema, clears the interstitial fluid improves the perfusion, increases the cell proliferation and so promotes the healing.
  • A perforated drain is kept over the foam dressing covered over the pressure sore.
  • It is sealed with a transparent adhesive sheet.
  • The drain is connected to the required vacuum apparatus.
• Once the ulcer granulates well, flip cover or skin grafting is done.
• Excision of the ulcer and skin grafting can also be done.
• Flaps—local rotation or other flips (transposition flaps).
• Cultured muscle interposition should be done.
• Proper care should be given to the patient, i.e.
• Change in position once in 2 hours; lifting the limb upwards for 10 seconds once in 10 minutes
• Use of water bed/air bed/air-flid floatation bed and pressure dispersion cushions to the affected area.
• Urinary and fecal care
• Hygiene should be maintained
• Psychological counseling should be done.
• Regular skin observation; keeping skin clean and dry (using regular use of talcum powder); oil massaging of the skin and soft tissues using clean, absorbent porous clothing; control and prevention of sepsis helps in the management.