Decubitus - destruction of soft tissue (skin subcutaneous tissue, mucosal wall of the hollow organ or blood vessel and al.), which arises due to circulatory disturbances caused by prolonged continuous mechanical pressure.
Their localization - bones protruding areas: elbows, buttocks, heels, ankles, the sacrum, the spine.
Pressure sores occur under the influence of pressure, without contributing to its development general condition disorders (e.g., there is if unsuccessful casting of) or develops on the background of gross violations of tissue nutrition, often with severe spinal injuries brain.
Causes of
There are 3 most important reasons that give rise to pressure sores:
- The pressure on places most frequent localization of extended body weight or limbs
- The friction forces when moving the patient on the sheet.
- Urinary incontinence due to humidity or perspiration increases the friction between the two surfaces.
Under what conditions arise?
- Immobility (e.g., stroke).
- Malnutrition and low body weight.
- Fecal incontinence.
- Urinary incontinence.
- Bone fractures (especially hip).
- Deficiency of vitamin C.
- Low blood pressure.
- Age-related skin changes: increased sensitivity to pain, thinning of the skin, decreased immunity.
- Infectious diseases.
- Anemia.
- vascular disease.
- Sugar diabetes.
- Malignant tumors.
- Cerebrovascular disease (e.g., stroke).
- Dry skin.
- Edemas.
Symptoms of pressure ulcers in stages
Pressure sores are classified according to 4 stages, in accordance with the symptoms.
Stage I: skin redness without blanching, the affected area is warm to the touch, painful.
Step II: violation of the integrity of the skin, the presence of bubbles to discharge, reddening of the skin is more pronounced increase in the affected area, swelling temperature.
Stage III: formation of ulcers with detachable (ulcer extends no deeper skin), wound under the crust.
Stage IV: ulceration applied to muscle or bone, surrounding tissue destruction (visible damage does not reflect the true area necrosis).
Treatment
- Local treatment of pressure ulcers forming a thorough toilet area includes a modified skin. Toilet produce saline hydrogen peroxide. After thorough drying closet performed its surface and processing means at the unbroken integrity of the skin, improving local circulation (aktovegin, Solcoseryl).
- High calorie diet with high protein content, supplementation of zinc sulfate, vitamins A and C, iron.
- Physical activity - movement to the maximum achievable range for the patient or active exercises if they are possible.
- Maintenance Therapy: ascorbic acid 500 mg 2 times a day.
- Antifungal ointment on the testimony of: miconazole, clotrimazole.
- Topical antibacterials: silver sulfadiazine, sodium sulfadiazine, clindamycin, gentamicin, chloramphenicol.
- Enzymatic detergents locally: collagenase, trypsin, plasmin DNase, papain, iruksol.
- Radical surgery deep and complex bedsores: overlay myocutaneous flap, skin transplantation.
The average period of hospitalization in the treatment of bedsores - 46 days. With good medical care of the patient with pressure sores in 79% improved, 40% are completely healed.
Prevention of bedsores
Basic prevention against bedsore includes:
- Turning the patient in bed every 2 h. This can completely prevent the formation of pressure ulcers.
- The use of funds aimed at reducing the pressure force, as well as ensuring its continuity (plastic tire, special beds and mattresses, cushions and pads, which are filled with foam, water, gel, air or a combination of these materials). Discontinuity successfully pressure factor is provided with an adjustable pressure and vibration systems which reduce pressure on the skin.