A pressure ulcer is an injury to the skin or tissue over a bony area. A pressure ulcer is also called a pressure sore, bedsore, or decubitus ulcer. Pressure ulcers can form over any bony area but are most common on the back, buttocks, hips, and heels.
What causes pressure ulcers?
- Continuous pressure builds when one sits or lies on a bony area for too long. Pressure slows or stops the blood from flowing to the skin. This may hurt the skin and cause tissue damage. Pressure can start to cause damage to one’s skin and tissue about 2 hours after staying in the same position.
- Shearing or friction happens when delicate skin is dragged across a surface, such as sheets. This may cause one’s skin to tear or a blister to form. Sliding up or down in bed or moving from the bed to a chair may tear one’s skin. Muscle spasms may cause one’s arms or legs to jerk and rub the sheets, causing tears in one’s skin.
What increases the risk for a pressure ulcer?
What are the stages of a pressure ulcer?
- With a deep tissue injury, the patient’s skin is not broken. He may see purple or red skin, or a blister. The skin may feel warm, spongy, or tight when the patient touches it.
- At stage 1, the patient’s skin is not broken, but it may itch or hurt. The skin may feel warm, spongy, or tight when he touches it. The skin may stay red for more than an hour after pressure is removed from the bony area.
- At stage 2, the skin has broken. The patient may have an open sore and the area around it may be red and raw. The skin may sink inward and look shiny or dry.
- At stage 3, the tissue below the skin is damaged. The area looks like a deep crater, or bowl-shaped hole. There may be more damage hidden under the skin than what the patient can see.
- At stage 4, the sore is very deep and tendons, muscle, and bone may be damaged. The patient may be able to see the tendons, muscle, and bone in the wound.
- With an unstageable wound, it is hard for healthcare providers to see what stage one’s pressure ulcer is in. This is usually because there is a lot of dead tissue or scabbing in the wound.
How is a pressure ulcer diagnosed?
The healthcare provider will ask about the patient’s pressure ulcer and examine him. Tell the doctor when the pressure ulcer started and if it is getting bigger or changing color. The doctor may ask if the patient is having pain or numbness over any bony areas. The patient may need any of the following:
- A sample of fluid, tissue, or bone from the patient’s wound may show a bacterial infection. This will help the healthcare provider plan the patient’s treatment.
- Blood tests may show if the patient is having a bacterial infection.
- An x-ray, ultrasound, or MRI may show the tissues around the patient’s ulcer and the bone under the ulcer. He may be given contrast liquid to help the bone and any infection show up better in the pictures.
How is a pressure ulcer treated?
The patient may need any of the following treatments depending on the stage of his pressure ulcer:
- Bandages may be needed to protect the patient’s skin or wound. The healthcare provider will choose the best bandage for his wound.
- Medicines may be given to decrease pain or to help treat or prevent a bacterial infection. Ask how to take these medicines safely.
- Debridement is a procedure used to clean out dead tissue from a serious ulcer. Dead tissue may keep the wound from healing. Debridement allows healthy tissue to form so your wound can heal.
- Negative pressure wound therapy (NPWT) uses a machine called a wound vac, wound vacuum, or pump to help with wound healing. Suction from the machine removes excess drainage from the patient’s wound and pulls wound edges closer together.
- Surgery may be needed to close the patient’s wound. This is called a flap closure. A skin flap (piece of skin) is usually taken from an area close to the wound. One end of the skin flap often remains attached while the other end is moved to cover the patient’s wound. The skin flap is secured with stitches or staples.