Causes of Pressure Ulcers
Pressure ulcers, also known as bedsores or pressure injuries, develop when prolonged pressure is placed on areas of skin over bony prominences like the heels, hips, ankles, shoulders, and back of the head. The pressure cuts off blood supply to the affected area and if not addressed, can extend into underlying muscle, tendons, or bone. Some common causes of pressure ulcers include:
- Immobility: Being confined to bed or a wheelchair for extended periods without enough shifting of weight or Pressure Ulcers Treatment pressure relief increases risk. This is especially a problem for patients in hospitals, nursing homes, or who have limited mobility due to medical conditions.
- Malnutrition: Not getting enough nutrition, protein, vitamins, and minerals leaves the skin more vulnerable to breakdown from pressure. Conditions like unintentional weight loss, anorexia, malnutrition, or significant weight loss surgeries raise risk.
- Moisture: Sweat, urine, or stool that remains on the skin for prolonged periods can create a warm, moist environment where bacteria and fungus thrive, damaging the skin. Incontinence or poor perineal hygiene increases risk.
- Advanced age: As we age, skin becomes thinner, less elastic, and heals more slowly, making older individuals more susceptible to ulcer development from less intensive pressure.
Staging and Grading of Pressure Ulcers
Pressure ulcers are staged or graded based on their depth and severity from I to IV. Stage I is the least severe, involving intact skin with non-blanchable erythema, while Stage IV is the most severe, involving full thickness tissue loss with exposed bone, tendon, or muscle. Common stages include:
- Stage I: Non-blanchable erythema of intact skin - noticeable redness of the skin.
- Stage II: Partial thickness skin loss involving damage to the epidermis and/or dermis - wounds are shallow and appear as open blisters or breaks in the skin.
- Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue extending to underlying fascia - wounds extend below the skin down to underlying tissues. Bone, tendon and muscle are not visible.
- Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage extending to muscle and supporting structures - wounds extend through skin, leaving bone, tendon or muscle visible.
Pressure Ulcer Treatment Options
Treatment and management of pressure ulcers depends on their stage or grade and severity. Mild pressure ulcers may heal with simple conservative treatments, while more severe wounds may require extensive wound care, debridement, surgery, and other intervention. Common treatment approaches include:
- Wound cleansing and debridement: Gently cleaning the ulcer with mild soap and warm water is essential. Necrotic tissue, slough, and debris are removed using sterile gauze or specialized debridement methods to promote healing of healthy tissues underneath.
- Pressure relief: Relieving pressure on the affected area through positioning, special support surfaces, wheelchair cushions, and frequent shifts in position is critical for healing. Elevating heels with donuts or special boots may help pressure ulcers on feet and ankles.
- Moist wound dressings: Covering ulcers with dressings that maintain a moist wound environment like hydrogels, hydrocolloids, alginates, or specialty foam dressings protects wounds and promotes granulation. Dressings are changed one to several times daily based on drainage and condition.
- Skin protection: Keeping intact skin well moisturized with barrier creams helps prevent further breakdown. Incontinence products for management of urinary or fecal incontinence also protect perineal skin integrity.
- Promoting circulation: Positioning techniques that increase circulation to affected areas like floating heels or 30 degree angled foot rests may speed healing of pressure ulcers on heels and ankles by enhancing perfusion of oxygenated blood.
- Nutritional support: Oral nutritional supplements high in calories, protein, and micronutrients support wound healing. Enteral tube feedings may be needed if significant unintentional weight loss or malnutrition exists.
- Advanced treatments: For severe, non-healing pressure ulcers, additional procedures such as surgical debridement of necrotic tissue, skin grafting to close wounds, and hyperbaric oxygen therapy may be recommended.
While pressure ulcers can develop in anyone, careful skin inspections, diligent preventative care, and prompt pressure ulcers treatment of any areas of concern go a long way in prevention and healing. With a multidisciplinary team approach focused on offloading pressure and optimizing other underlying risk factors, most wounds can heal successfully.
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