Why do bedsores appear?
The main mechanism is the body's pressure on the tissue between the bony protrusion and the surface of the bed or chair. The vessels are compressed, the tissues stop receiving oxygen, and after a few hours their death begins. The situation is aggravated by friction when a person is pulled up over the sheet and displacement of layers of skin when the head of the head is raised and the body slides down. Additionally, moisture from sweat and urine, lack of protein in the diet, dehydration, anemia, diabetes and sensory disorders in which a person does not feel discomfort damage the skin.
- Prolonged pressure on bony prominences
- Friction when moving across the sheet
- Displacement of skin layers when raising the head of the bed
- Humidity with incontinence and sweating
- Protein deficiency and dehydration
- Diabetes mellitus and sensory impairment
Stages
At the first stage, the skin is intact, but persistent redness appears, which does not fade when pressed with a finger; on dark skin it may look like an area of a different shade and thickening. On the second, the surface layer is damaged: a bubble or shallow abrasion occurs. The third stage is a wound to the full thickness of the skin involving the subcutaneous tissue. The fourth is a deep defect in which muscles, tendons or bone are visible. Separately, there are bedsores under a dense scab, the depth of which cannot be assessed before its removal.
- Stage 1: persistent redness with intact skin
- Stage 2: Blister or superficial abrasion
- Stage 3: wound to subcutaneous tissue
- Stage 4: defect with exposed muscle and bone
- Bedsore under scab: depth unknown
Prevention is key
The body position is changed every two hours during the day and at least every four hours at night, using pillows and bolsters to unload the sacrum and heels. It is better to raise your heels completely above the mattress. The sheet should be straightened, without wrinkles or crumbs. The skin is examined daily, especially in risk areas, washed with mild detergents and thoroughly dried by blotting; for incontinence, absorbent agents and protective creams are used. An anti-bedsore mattress, sufficient fluids and a diet with sufficient protein are important. Do not massage reddened areas.
- Change position every 2 hours
- Unload the heels and sacrum with pillows
- Straighten the sheet, avoid wrinkles
- Inspect the skin in risk areas daily
- Anti-bedsore mattress
- Enough protein, fluid and vitamins
- Do not rub reddened skin
Wound treatment
The first and mandatory condition is to completely remove the pressure from the affected area, otherwise no means will help. The wound is cleaned with saline solution, dead tissue is removed, for which the surgeon performs treatment for deep bedsores. Next, a modern dressing is selected depending on the amount of discharge: it maintains a moist environment and does not stick to the wound. Antibiotics are not prescribed to everyone, but only when there are signs of infection spreading. Be sure to correct nutrition, anemia and glucose levels, and anesthetize dressings. Do not apply brilliant green, iodine or alcohol solutions to the wound.
- Completely relieve pressure from the area
- Washing with saline solution
- Removal of dead tissue by a surgeon
- Modern bandages instead of gauze with ointment
- Antibiotics only for signs of infection
- Eating with enough protein
- Do not use brilliant green, iodine or alcohol on the wound
When do you need a doctor?
An examination by a specialist is necessary if the wound does not decrease after two weeks of proper care, increases in size, purulent discharge with an odor appears, the skin around it turns red and swells, and the temperature rises. These signs indicate an infection that can spread to soft tissue and bone. Deep bedsores of the third and fourth stages are always managed by a surgeon: sometimes it is necessary to cover the defect with a skin flap. General deterioration of the condition, confusion and chills in a bedridden patient is a reason for urgent treatment.
- The wound does not heal for more than two weeks
- Purulent discharge and odor
- Widespread redness and swelling
- Fever and chills
- Exposure of bone or tendons
- Confusion in a bedridden patient
