Bedsores

Also called "pressure sores" or "decubitus ulcers," bedsores are skin ulcers that can occur when medical patients are confined to beds or wheelchairs without being able to change position for extended periods. They develop as a result of decreased circulation caused by a combination of the natural decrease in blood flow that comes with ageing, vascular disease, and decrease in circulation cause by external pressure.  Most bedsores attack areas of the body that press against adjoining surfaces, where they must always bear the patients' weight. These areas can include the buttocks, tailbone and shoulder blades — along with the skin behind the knee, the ankle and the heel of the foot. This may sound like a minor health problem, but it can quickly become life threatening as ulcers deepen and expose underlying tissue to potentially lethal infections.

Thousands of Americans, most of them older, die from bedsores each year, after they become incapacitated through illness or injury and wind up immobilized in hospital beds or wheelchairs. 

The sores begin to form when gravitational pressure against the skin reduces the flow of blood in the tiny vessels that provide its nourishment. After two or three hours of inadequate blood supply, tissues begin to die at these "pressure points" — producing ulcers that can extend deep into underlying layers of fat, muscle and even bone. In most cases, the condition begins with mild redness in the area of the pressure point. But these zones of irritation can deepen into crater-like ulcers within hours, if the blood supply is not restored to affected areas by turning the patient to relieve the pressure. Once ulceration sets in, the affected tissues can deteriorate rapidly, triggering massive cell-death and discharges of foul-smelling pus from infections.

If untreated, deepening bedsores can cause intense pain, while also leaving the patient vulnerable to invading bacteria. Poor nourishment and anemia, which often occur among the elderly, can also contribute to the development — or slow healing — of pressure ulcers. At the same time, older patients with immune systems already compromised by aging or illness face a heightened risk from bed sore-related infections.

Bedsores usually develop through four basic stages: First: The patient begins to develop warm, reddish or purplish areas of skin (most often over bones or joints) at the site of pressure points. Second: The ulceration first appears as a small break, crater or blister in the skin. Areas around the lesion are now inflamed and usually red. Third: The deepening ulcer reaches the layer of fat just beneath the skin. In many cases, it will now begin to drain a foul-smelling, yellowish-greenish pus — the sign of a bacterial infection. Fourth: As the ulcer deepens into areas of muscle or bone, the drainage increases, and the patient frequently experiences intense pain. Without treatment, the condition can worsen to the point that surrounding layers of fat and muscle will begin to die, opening the door to dangerous infections.

What to Do

To prevent bedsores, change the position of a bedridden patient every two hours. (Wheelchair-confined patients should be "turned" at least once an hour.) Lift patients into their new positions, rather than risking injury to sensitive tissues by dragging them. Keep both the patient's skin and surrounding bedding clean. Apply cornstarch to skin at pressure points to reduce friction from clothes or bedding. Be careful to inspect the patient's skin at least once a day for reddish or purplish areas that could indicate the beginning of a bed sore. Seek medical attention immediately if reddish areas on the patient's skin do not begin to disappear as soon as the pressure against them is relieved. Always seek medical attention at the first sign of a break in the skin.

Use Medicine Effectively

The doctor may prescribe oral or topical antibiotics.

Self-care Steps for Bedsores

Specially designed mattresses and "egg-crate" cushions can reduce pressure against skin, thus reducing the risk of ulcers. For bedridden patients, place pillows beneath the legs between mid-calf and ankle, which will lift the heels from the mattress. Position more pillows to keep knees and ankles from rubbing against each other. Protective padding can be deployed at other pressure points as well to further reduce the risk of ulcers. Do not raise the head of a patient's bed, because it will increase gravitational pressure against the lower limbs. Good nutrition and plenty of fluids are key weapons for healing sores and potential infections. Clean sores frequently, being careful to rinse away dead tissue, then apply medically prescribed ointments designed to promote healing and fight infections.