What are they?
Pressure sores (or decubitus ulcers) are areas of dead broken skin that become sore and refuse to heal. These ulcers are a result of blood supply to the skin cut off for too long due to pressure while lying or sitting still for a long period of time. The ulcers thus occur in those areas with bony points in direct contact with the bed or chair, eg the hips, heels, shoulder blades and back of the head.
Healthy people avoid getting this problem because they are able to change positions from time to time, even unconsciously when asleep. But in unconscious or paralysed people, or people too ill and weak to move, these ulcers can easily develop.
Poor nutritional status, softening of skin by sweat or urine, and infection predispose and hasten the development of decubitus ulcers. The ulcer may be quite large, and muscles, tendons or bones may be exposed.
How can I prevent them?
Any person at risk of developing decubitus ulcers needs to have the following done for them:
- Turning them every 2-3 hours.
- Adequate skin care by massage to encourage blood circulation and powdering to help absorb heat.
- The bed must be clean and sheets must not be creased.
- The use of special soft beds or water beds.
- Allow the person to walk around as soon as they are able to.
What are the warning signs?
These are necessary to detect areas of poor blood supply early to prevent ulcers from developing. They include:
- A discoloured skin patch.
- Hard or cracked skin
- Patches of skin that are shiny, too warm, too cold, or too dry.
What treatments work?
Careful cleaning and dressing of the wound are usually all that's needed to treat pressure sores. When the wound becomes clean, it may be covered with skin graft, or if it is deep by a flap of muscle and skin.
Nutrition must also be improved. The dietician will help with this.
For painful pressure ulcers, simple painkillers such as paracetamol and ibuprofen are usually enough. Pain-relieving creams may also be applied directly around the wound. If stronger painkillers are needed, the doctor can prescribe them.
If the pressure sore becomes infected, antibiotics will have to be prescribed based on the offending organism.