Decubitus Ulcers

Key Points
More commonly known as bedsores or pressure ulcers
Caused by a number of factors, including friction and unrelieved pressure
Can be fatal if not treated

Decubitus ulcers, or pressure sores, are caused when you sit in one position for too long without shifting your weight causing the skin to break down. This often happens to people who are bedridden or limited to a wheelchair. Malnourishment, incontinence, and chronic conditions such as diabetes, which prohibit blood flow, can also cause the condition. The constant pressure to one part of the skin precludes blood from getting to that area, causing the affected tissue to die. It can range in color from a bright pink to a deep red wound. While it can affect any part of the body, it occurs most often on bony areas, such as elbows, knees, ankles, or at the base of the spine. It is easily preventable, but if it’s not treated, it can be fatal.

There are four stages of Decubitus ulcers reflecting the deepness of the wound.

Stage I: A reddened area on the skin that, when pressed, does not turn white.
Stage II: The skin blisters or forms an open sore.
Stage III: The skin breakdown looks like a crater.
Stage IV: The pressure ulcer is so deep that it causes damage to muscle and bone, and sometimes tendons and joints.

Differential Diagnosis (Other conditions with similar appearance)

Leg Ulcer
Stasis ulcer
Venous Insufficiency
Lymphedema
Ischemic ulcer
Vasculitic ulcer

Diagnosis
Diagnosis can be made upon visual inspection. Lab work, such as a tissue Biopsy, is done only to rule out bacterial infection. If there is a foul odor, redness and tenderness around the ulcer, or if the skin close to the ulcer is warm and swollen, a medical professional should immediately be consulted.

Do not massage the ulcers.

Treatment
Eliminate the cause
Pressure reduction devices
Frequent turning and repositioning
Proper wound care
Proper nutrition

The first step in treating Pressure sores is to eliminate the cause, or the pressure. You should turn or reposition yourself at least every two hours. Use pillows, sheepskin, foam padding, and powders to help alleviate the pressure. Eat well, exercise daily, and keep the skin clean and dry, especially after urine or bowel movements.

If bedsores nevertheless form, there is a multi-step approach to treating them. First, the dead skin should be removed. Apply antiseptics and antimicrobials to prevent infection. Eat the appropriate foods to support healing (a dietitian should be consulted). Where necessary, caregivers should be properly educated so as to help the patient prevent further bed sores.

If the pressures sores reach the Stage III or Stage IV levels, surgery may be necessary to deal with the wounds. Surgeries may consist of skin grafts or closure of the wounds. There is also a method called Negative Pressure Wound Therapy that allows negative pressure to be applied to the wound.

Care should also be taken to ensure the pressure sores do not contribute to additional ailments.