Treatments for Bed Sores - Warning signs & Risk factors

What are bed sores?

• Bedsores are also called decubitus ulcers, pressure ulcers, or pressure sores. They begin as tender, inflamed patches that develop when a person's weight rests against a hard surface for prolonged periods, exerting pressure on the skin and soft tissue over bony parts of the body.

How do bed sores develop?

• Bed sores are a localised area of tissue injury that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. 
• The external surface may be a mattress, a chair or wheelchair, or even other parts of the body. The soft tissues of the body, such as skin and muscle, depend upon blood vessels to carry nutrients to the tissues, and to remove waste products. 
• Bed sores result when prolonged pressure prevents sufficient blood flow to supply the tissues with nutrients. The resulting bed sore represents the death of the involved soft tissues.

What are the warning signs?

• Increased redness of skin over a bony prominence.
• An increase in the size or drainage of the sore.
• The sore starts smelling and/or the drainage become a greenish colour.
• You develop a fever.

What are its risk factors?

• Immobility
• Age
• Incontinence
• Malnutrition and dehydration
• Diseases and disorders that slow healing or lessen mental awareness
• Diseases and disorders such as confusion or dementia that lessen mental awareness and may prevent a person from feeling the discomfort of a harmful body position. Similarly, in diabetics and other peripheral nerve disorders, lack of sensation may prevent early detection of pressure sores
• Medications, particularly sedatives

What are its stages?

Pressure sores are categorized into four key stages depending on their age and severity.

Stage One - Skin is not broken but is red or discolored. The redness or change in color does not fade within 30 minutes after pressure is removed.

Stage Two - The epidermis or topmost layer of the skin is broken, creating a shallow open sore. Drainage may or may not be present.

Stage Three - The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in Stage Two.

Stage Four - The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.

How can bed sores be treated?

The best treatment is to prevent them from developing, because once the skin is broken it is difficult to treat them. Treatment for bed sores is in accordance to the severity of bed sores. There are several aspects to treating bed sore:

• Remove pressure on the affected area by changing the position or providing padding
• Keep the wound clean and dry
• Protect the wound with medicated gauze or other special dressings
• Cover the wound with skin grafts or skin flaps. This means transplanting healthy skin to the wound area.

Open wounds are slow to heal, and because skin and other tissues that have already been damaged or destroyed, never heal perfectly. Patients require the care of nurses and physician that are trained to look after pressure sore. A plastic surgeon may be called to provide skin cover to large pressure sores that do not heal with medications.

How can bed sores be prevented?

Bed sores can be prevented by regular inspection of the skin for areas of redness. Anticipatory care should be started in:

• Elderly or malnourished patients
• Patients that are lying in bed for long periods such as after head injury, brain or spine operation, other debilitating neurological diseases
• Diabetics

The following tips also help

• Preventing progression of existing bed sores include frequent turning and repositioning
• Providing soft padding in wheelchairs and beds to reduce pressure
• Providing good skin care by keeping the skin clean and dry
• If an area of skin is red or discolored but not broken, keep pressure off the sore, wash it gently with mild soap and water, dry thoroughly, and apply a protective wound dressing.
• Contact doctor immediately if person notice any broken skin or open sores.
• Get immediate medical care if he has signs of infection: fever, drainage from the sore, a foul odor, or increased heat and redness in the surrounding skin.