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Pressure Ulcers - Causes, Signs, Risk Factors, Prevention, and Treatment

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Pressure ulcers are injuries that affect the skin and underlying tissues when prolonged pressure is applied to the skin. Read on to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At February 8, 2023
Reviewed AtJuly 14, 2023

Introduction

Pressure ulcers are a type of damage or injury that breaks the skin and underlying tissue when the skin is kept under constant pressure for a prolonged period, leading to the cessation of nutrient and oxygen supply. In the absence of enough blood to replenish nourishment of the skin, the skin may die and form ulcers. Pressure ulcer tends to form in the region where the skin covers the bony areas with less tissue under the skin. Common sites where the pressure ulcer develops are the elbow, buttocks, heels, hips, ankles, back, and shoulder. There are several stages of pressure ulcers depending upon the severity. Prevention of pressure ulcers is very important to prevent their severity.

What Are Pressure Ulcers?

Pressure ulcers are also known as bedsores. They are injuries to the skin and other underlying tissue that results from prolonged pressure on the skin. Bedsores often develop on the skin that covers bony areas of the body, such as ankles, hips, tailbone, and heels. People are often at risk of developing pressure ulcers with certain medical names. Pressure ulcers can develop over hours or days. Most ulcers heal with treatment.

What Are Common Sites of Pressure Ulcers?

The common sites of pressure ulcers:

  • Buttocks or tailbone.

  • Shoulder spine or blades.

  • Back of legs or arms where they rest against the chair.

  • The shoulder blade.

  • The lower back, hip, or tailbone.

  • The ankles, heels, and skin behind the knees.

What Are the Causes of Pressure Ulcers?

Pressure ulcers are caused due to excessive pressure experienced against the skin that limits the blood flow to the skin. Limited movement makes the skin vulnerable to damage and develops pressure ulcers. The contributing factors of pressure ulcers are:

  • Pressure: Constant pressure on body parts can reduce the blood flow to the tissues. Blood flow is important for delivering oxygen and nutrients to the tissue. Without these essential skin and nutrients are damaged and can eventually die.

  • Friction: Friction occurs as the skin rubs against the bedding or clothing. It can make the skin fragile and vulnerable to injury, especially if it is moist.

  • Shear: Shear occurs when two surfaces are in the opposite direction. For example, when a bed is elevated at the head.

What Are the Symptoms of Pressure Ulcers?

The symptoms of pressure ulcers are as follows:

  • Swelling.

  • Unusual changes in texture or skin color.

  • Pus-like draining.

  • Tender areas.

  • An area of skin that feels warmer or cooler to the touch than other areas.

  • Presence of broken skin.

What Are the Stages of Pressure Ulcers?

The stages of pressure ulcers are as follows:

  • Stage 1: A painful, reddened area present on the skin that does not turn white when pressed. It is a sign of pressure ulcer development. The skin may be cool or warm, soft or firm.

  • Stage 2: The skin blisters form an open sore. The area around the sore may be irritated and red.

  • Stage 3: In this stage, the skin develops into a sunken open hole called an ulcer or crater.

  • Stage 4: The pressure ulcer becomes too deep, which results in damage to bone and muscles and sometimes to joints and tendons.

What Are the Risk Factors for Pressure Ulcers?

The risk factor for developing pressure ulcers is higher if there is difficulty moving and one cannot change position easily while seated or in bed. Risk factors include:

  • Immobility: This occurs due to spinal cord injury and poor health.

  • Incontinence: Skin sometimes becomes more vulnerable with increased exposure to stool and urine.

  • Lack of Sensory Perception: Neurological disorders and spinal cord injuries result in sensation loss. An inability to feel discomfort can result in being unaware of warning signs and the need to change position.

  • Poor Hydration and Nutrition: People need enough calories, vitamins, protein, and minerals in daily diets to maintain healthy skin and prevent tissue breakdown.

  • Medical Condition Affecting Blood Flow: Health problems affect blood flow, such as vascular diseases and diabetes, which can elevate the risk of tissue damage, such as pressure ulcers.

What Are the Complications of Pressure Ulcers?

The complications of pressure ulcers include:

  • Cellulitis: It is a skin infection that can cause swelling and inflammation of the affected area. Sometimes people with nerve damage do not feel pain.

  • Bone and Joint Infection: It is an infection resulting from a pressure sore that burrows into bones and joints. Joint infection can damage tissue and cartilage. Bone infections can reduce the function of limbs and joints.

  • Cancer: Non-healing or long-term wounds can also develop into a type of cancer called squamous cell carcinoma.

  • Sepsis: Pressure ulcers can rarely result in sepsis.

How to Prevent Pressure Ulcers?

The ways to prevent pressure ulcers are as follows:

  • The skin should be washed and pat dry. The cleaning routine should be followed regularly.

  • A moisture barrier cream can be used for skin protection. Bedding and clothing should be changed frequently.

  • Use a mattress or cushions to relieve pressure and ensure that the body is well-positioned.

  • The bed should not be elevated more than 30 degrees. This helps in the prevention of shearing.

  • Regularly changing the position when sleeping.

  • Having a healthy and balanced diet that contains a good variety of vitamins, minerals, and enough protein.

  • Quitting smoking reduces the chances of pressure ulcers.

  • Regular exercise is also essential for preventing pressure ulcers.

How to Treat Pressure Ulcers?

Treatment of pressure ulcers involves:

  • Application of dressing in order to speed up the healing process and for relieving pressure.

  • Regularly changing the position.

  • Use of specially designed cushions or mattresses that pump to provide constant airflow.

  • Eating a balanced and healthy diet.

  • Antibacterial creams can be used to combat infections and barrier creams for protecting vulnerable and damaged skin.

  • Debridement, a procedure to clean and remove damaged skin or tissue, can be performed to treat pressure ulcers.

  • Irrigation can be used to wash away the dead tissue, and later the wound is closed.

  • Laser treatment can be done to remove dead skin.

  • Biosurgery can be done by using maggots to eliminate bacteria from the wound.

Conclusion

Pressure ulcers can affect anyone but usually affects people confined to a chair or bed for a longer period of time. It is possible to decrease the risk of pressure ulcers. A sore seen at an early stage can be prevented in the home. The ulcer can sometimes be life-threatening, and the person has to be hospitalized.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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