Aetiology

Pressure ulcers (bedsores, skin ulcers) are lesions that occur as a result of poor blood flow and a skin irritation that covers a bony part of the body in areas where the skin has been put under pressure by a bed, wheelchair, cast, splint or other rigid object for a long period of time. In Spain, 8.8% of patients admitted to hospital suffer them, 7.6% of all elderly people in nursing homes and 8.3% of all elderly people who stay at home, with an associated mortality rate of 8%. This last figure contrasts with the fact that 95% of pressure ulcers can be avoided, if efforts are made to ensure that a mild irritation or eritematose lesion does not evolve towards more advanced stages characterised by the destruction of the dermis, epidermis and adjacent tissue.

Symptoms

These ulcers are usually produced by pressure on the skin that obstructs the blood flow. This lack of irrigation leads to reddening and inflammation that, if it is not cured in time, leads to ulceration of the skin.

Patients

People with mobility problems are at greater risk of developing pressure ulcers. This group includes paralysed persons or those who are very weak or live as recluses. Also prone are people who do not feel discomfort or pain, which are signals that induce movement, as well as persons with malnutrition who do not have a protective fatty layer and their skin –deprived of essential nutrients- does not heal wounds well. Pressure ulcers usually cause some pain and irritation.

Stages of the illness

Pressure ulcers are classified by the stage they are at. In stage 1 the ulcer is not really formed; the intact skin simply has a reddish colour. In stage 2 the skin is red and inflamed (quite often with blisters) and its outer layers start the process of destruction. In stage 3 the ulcer opens out through the skin, leaving the deeper layers exposed. In stage 4 the ulcer extends deep into the skin and fat as far as the muscle. The muscle is destroyed in stage 5. In stage 6, the deepest stage of pressure ulcers, even the underlying bone can be seen, damaged and sometimes infected. Pressure ulcers are painful and can put the patient’s life at risk.

Treatment

Prevention is the top priority and deep pressure ulcers can almost always be prevented through intensive care. This includes a careful daily inspection of the skin and its protection by changing the patient’s position and using protective and antiseptic products.

Treating a pressure ulcer is much more difficult than preventing it. When the skin breaks up, protecting it with a gauze dressing may help to heal it. If the ulcer appears to be infected or is oozing it needs to be rinsed, gently washing it with soap or disinfectants that can eliminate the infected (dead) material. Sometimes the doctor needs to eliminate (debride) the dead material with a scalpel. Some cases require a transplant of healthy skin to the damaged area. Unfortunately, this kind of surgery is not always possible, especially in elderly people. The prevention and control of the illness is the most efficient way to treat this condition, so it is necessary to stop a mild irritation or erythema (stage 1) from evolving to more advanced stages.