Wound Care

What is Pressure Ulcers?

They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time.  Decubitus ulcers often occur on the skin covering bony areas. The most common places for a decubitus ulcer are your:

• hips
• back
• ankles
• buttocks

This condition is common among people who:

• are older
• have decreased mobility
• spend long periods in bed or a wheelchair
• can’t move certain body parts without help
• have fragile skin

The condition is treatable, but chronic deep ulcers can be difficult to treat. The specific outlook depends on several factors, including underlying medical conditions as well as the stage of the ulcer.

What are the symptoms of a decubitus ulcer?

They often develop gradually, but can sometimes form in a few hours.

Early symptoms

Early symptoms of a pressure ulcer include:

Stage 1

The skin isn’t broken, but it’s discolored. The area may appear red if you have a light complexion. The discoloration may vary from blue to purple if you have a dark complexion. It may also be warm and swollen. Pain or itchiness in the affected area.

Later symptoms

The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:

Stage 2

There is breakage in the skin revealing a shallow ulcer or erosion. There might also be a blister filled with fluid.

Stage 3

The ulcer is much deeper within the skin. It affects your fat layer and looks like a crater.

Stage 4

Many layers are affected in this stage, including your muscle and bone.

Unstageable

A dark, hard plaque called eschar may be inside the sore, which makes full evaluation and staging difficult. Sometimes your doctor requires further imaging or surgical evaluation of the area to determine the full extent of the ulcer. The ulcer may also have discolored debris known as slough (yellow, tan, green, or brown), which makes full evaluation difficult.

Who’s at risk for a decubitus ulcer?

There are a number of risk factors for decubitus ulcers:

• You may be at risk if you can’t move or change positions by yourself while lying in bed or sitting in a wheelchair.
• Your skin may be more fragile and delicate if you’re an older adult (being over 70), which can put you at increased risk.
• Inability to move some or all of the body (paralysis)
• Obesity
• Urinary incontinence and bowel incontinence
• Poor eating habits or not getting enough nutrients in your diet may influence the condition of your skin, which can increase your risk.
• Conditions like diabetes may restrict your blood circulation, which can cause tissue destruction in your skin and increase your risk.

Diagnosing a decubitus ulcer

Your healthcare provider may refer you to a wound care team of doctors, specialists, and nurses experienced in treating pressure sores. The team may evaluate your ulcer based on several things. These include:

• the size and depth of your ulcer
• the type of tissue directly affected by your ulcer, such as skin, muscle, or bone
• the color of the skin affected by your ulcer
• the amount of tissue death that occurs from your ulcer
• the condition of your ulcer, such as presence of infection, strong odor, and bleeding

Your healthcare provider may take samples of the fluids and tissue in your decubitus ulcer. In addition, they may look for signs of bacteria growth and cancer.

Treatment/Prevention

Treatment options for pressure ulcers (sores) typically include regularly changing your position, using special mattresses to reduce or relieve pressure, and dressings to help heal the ulcer. In some cases, surgery may be needed.

Changing position

Moving and regularly changing your position helps to relieve the pressure on ulcers that have already developed. It also helps prevent pressure ulcers developing. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every two to four hours.

You may also be given training and advice about:

• correct sitting and lying positions
• how you can adjust your sitting and lying positions
• how best to support your feet to relieve pressure on your heels
• any special equipment you need and how to use it

Mattresses and cushions

If you’re at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend a specially designed static foam or dynamic mattress.

If you have a more serious ulcer, you will require a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress itself.

There are also a range of foam or pressure-redistributing cushions available. Ask your carer about the types most suitable for you.

Specially designed dressings can be used to protect pressure ulcers and speed up the healing process.

Dressings

These dressings include:

Alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process

Hydrocolloid dressings – contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy skin dry

Foams, made from hydrophilic polyurethane, highly absorbent. Decreases maceration of periwound tissue. May be used as primary dressing for treatment of hypergranulation

Lipidocolloid/Collagen – to stimulate wound repair and epithelial activity

Composite products – most have three layers: a semi-adherent or non-adherent layer to protect the wound bed, an absorbent layer and a moisture vapor permeable layer with an adhesive border.

Other dressing types – films, hydrofibres/gelling fibres, gels and antimicrobial (antibiotic) dressings may also be used

Ask your carer about which type of dressing they’re using for the management of your pressure ulcer.