Treatment of bedsores by stages. The initial stage of bedsores. Risk factors for developing pressure ulcers

– this is necrosis of soft tissues that occurs as a result of disruption of their nutrition and prolonged pressure on a certain area of the body. The development of pathology is facilitated by the patient’s limited mobility, insufficient care, and impaired sensitivity and trophism. Bedsores usually occur in areas where bony protrusions adhere to the skin (sacrum, heels, shoulder blades). Treatment tactics depend on the depth and stage of necrosis. For superficial bedsores, dressings are performed; for deep lesions, excision of dead tissue is necessary.

ICD-10

L89 Decubital ulcer

General information

– tissue necrosis that occurs as a result of prolonged pressure in combination with impaired innervation and blood circulation in a certain area of the body. Develops in weakened bedridden patients. In addition, bedsores can appear in patients with fractures due to the pressure of a cast that is too tight or uneven, as well as in people with dentures (if they do not fit well).

The likelihood of developing a pressure ulcer depends primarily on two factors: the quality of care and the severity of the disease. In some cases, the appearance of bedsores is quite difficult to avoid and for their prevention it is necessary to use a whole arsenal of special means: anti-bedsore mattresses, special absorbent diapers, circles placed under certain areas of the body, etc.

Causes of bedsores

The main cause of pathology is compression of tissue between the bone and the external hard surface. Soft tissues are compressed between the bone and the bed or the bone and the wheelchair, which leads to poor circulation in small vessels. Oxygen and nutrients cease to flow to the cells of the compressed area, as a result, the tissue area becomes dead and dies.

Additional causes of skin damage in typical areas where bedsores form are friction and slipping. Friction from sheets or clothing occurs when the patient independently changes positions, or is turned over or repositioned by family members or nurses. workers. Sliding is promoted by too high a rise of the head end of the bed, in which the patient slides down, as well as an attempt to stay in a sitting or semi-sitting position without proper support.

The risk group for pressure ulcers includes all people with limited mobility, which can occur as a result of surgical interventions, paralysis, coma, sedation, weakness and general poor health, as well as diseases or injuries that require bed rest or the use of a wheelchair. The likelihood of developing the disease increases in smokers and older people, with poor nutrition and lack of fluids. Other factors that increase the risk of pressure ulcers include:

Deterioration of sensitivity due to neurological diseases, spinal cord injuries, etc. In such conditions, patients do not feel pain and discomfort, indicating compression of soft tissues. Bedsores in patients with paralysis tend to be protracted and persistent and can even occur in atypical places (for example, due to pressure from the edge of a shoe).
Weight loss and muscle atrophy. Muscle and fatty tissue are natural layers between the bony protrusions and the skin. As they decrease, the skin is subjected to increased stress under pressure. Therefore, bedsores often form in malnourished patients.
Skin that is too wet or too dry. The skin becomes dry when the temperature rises, and moist when there is increased sweating, which can be caused either by illness or by excessive overheating of the patient (too warm blanket, too high room temperature).
Urinary or fecal incontinence. Patients who lack bladder control often have moist skin, making it more vulnerable to pressure ulcers. And bacteria present in feces can contribute to the infection of bedsores and cause the development of severe local complications.
Diseases that cause circulatory disorders (diabetes mellitus, obliterating endarteritis, acute vascular occlusion, obliterating atherosclerosis).
Muscle spasms. With involuntary movements, the skin constantly suffers from friction against sheets, clothes and other surfaces.
Impaired consciousness. Patients cannot adequately assess their condition and refrain from actions that provoke the formation of bedsores or perform actions that prevent their occurrence.

Classification

Treatment of bedsores

Treatment of all lesions, even small and superficial ones, should be carried out with the participation of a doctor. Self-medication is unacceptable, since with this approach further progression of the pressure sore and the development of severe complications are possible. The basic principles of treating bedsores include restoration of blood flow in the damaged area, measures to promote the rejection of necrotic masses and wound healing.

To restore blood flow in the area of the bedsore, special preventive measures are taken, which will be discussed below. To stimulate the rejection of necrotic masses, special medications are used (clostridiopeptidase + chloramphenicol). If necessary, during primary treatment, areas of necrosis are removed using special instruments.

After the wound is completely cleared of necrotic tissue, dressings with alginates (special powder or wipes for filling wounds) are applied, hydrocolloid dressings and dressings with wound-healing preparations are applied. When a bedsore is complicated by a bacterial infection, local antiseptic and antibacterial agents are used. Elderly patients and patients with severe bedsores are treated with antibiotics. If a large defect has formed after a bedsore, skin grafting may be required.

Prognosis and prevention

The prognosis is determined by the severity of the bedsore and the nature of the underlying pathology. Prevention includes the following measures:

Daily skin checking is a mandatory procedure that should be carried out when caring for all seriously ill and disabled people. It is necessary to pay special attention to areas of bony protrusions and areas at risk of developing pressure sores.
To prevent bedsores, you should change the patient’s position in bed every 2-3 hours, use special devices (inflatable rings, etc.) and anti-bedsore mattresses. All movements of the patient should be carried out with the utmost care to avoid friction or stretching of the skin.
You need to use soft bedding and clothing made from natural materials. It is advisable that the clothes do not have buttons, fasteners or other elements that can create a source of increased pressure on the skin.
It is necessary to maintain a comfortable temperature in the room - not too low to prevent the patient from catching a cold, and not too high to avoid excessive sweating and the formation of diaper rash, which can later turn into bedsores.
Bed linen must be changed promptly, dry and clean. If necessary, special hygiene products (absorbent diapers, diapers, pads, etc.) should be used.

The skin of bedridden patients becomes thin and very vulnerable to damage, so caring for it must be careful and delicate. It is undesirable to use strong-smelling and alcohol-containing cosmetics, which can cause allergies and skin irritation. It is preferable to use special gentle hygiene products. It is necessary to ensure that the patient’s skin always remains dry and clean: wipe it with a soft towel if there is excessive sweating, remove natural secretions (feces, urine) from the skin as quickly as possible, and perform intimate hygiene after each bowel movement and urination.

Changing bed linen must be done using special techniques, turning the patient over and rolling him onto clean sheets, but in no case pulling the linen out from under him. The patient should also be encouraged to move and ensure that his diet is moderate, balanced, rich in minerals and vitamins, but relatively low in calories, since due to low mobility the number of calories needed in such cases is reduced.

Reading time: 6 minutes. Views 7.8k. Published 04/05/2018

Bedsores are a common problem caused by tissue death resulting from prolonged pressure on certain parts of the body. They occur in people who are limited in movement due to illness.

If not properly cared for, bedsores can deeply affect soft tissue, leading to the formation of deep wounds. Most often, this problem occurs in older people, since blood circulation deteriorates at this age, making it more difficult for tissues to recover.

Causes of bedsores

The main factor is the pressure of the hard surface on the protruding areas of the body. The most commonly affected areas are:

sacrum;
thoracic region;
shoulder blades;
back of the head

The vulnerability of these areas is due to the fact that there is a weak layer of muscle and fatty tissue between the bone and skin.

Let's celebrate! When lying on the side, the main part of the mass presses on the area of the femur and ilium. Frequently lying on your stomach is dangerous for the chest area. Sedentary patients are susceptible to the formation of pressure sores in the area of the ischial tuberosities, sacrum, feet, heels, shoulder blades and fingers.

Another cause of bedsores is friction and slipping. It occurs when the skin interacts with the sheet when the patient changes position himself, is either turned over or transplanted.

The main risk group for the disease includes people whose limited movement is associated with:

operations;
diseases and injuries requiring bed rest, or being on a wheelchair;
paralysis;
coma.

Other factors include:

sensory impairment associated with neurological diseases. In this case, the patient does not feel discomfort or compression of soft tissues;
elderly age. The older a person is, the thinner the skin becomes, we lose elasticity and the ability to heal quickly;
poor nutrition and insufficient fluid intake;
muscle atrophy and low weight. Adipose tissue, together with muscles, creates a layer that normally protects bone protrusions and skin;
increased moisture on the skin or dryness;
urinary or fecal incontinence. In patients with this problem, the skin is often wet, which creates an environment for bacteria to multiply;
muscle spasms. They lead to involuntary movements, the skin suffers from friction with the bed or clothing;
bad habits. Smoking leads to narrowing of blood vessels, hence the lack of oxygen.

All this leads to slow wound healing processes.

Stages and photos of bedsores in bedridden patients

There are four stages of development of pressure ulcers.

Stage 1 - initial

Formed as a result of impaired blood circulation in the skin. There are no significant external signs, since cell death has not yet occurred.

First, the affected area turns pale, then redness appears, which develops into swelling of a bluish or bluish tint.

Stage 2

Characterized by the formation of the first signs of cell death. The process takes place on the surface of the skin, without affecting muscle tissue.

At this stage, fluid bubbles and peeling may appear.

Stage 3

The development of necrosis descends to the depth of the dermis and affects the subcutaneous fatty tissue.

Deeper blisters continue to form in areas of thinned skin. If treated incorrectly, infection may occur and purulent lesions may form.

Stage 4

The most severe and advanced stage. All layers of tissue are affected, right down to the bones. At this stage, the bedsore looks like a deep wound through which tendons and bone tissue can be seen.

If an infection occurs, bones and joints may be affected.

Complications of bedsores

Improper care and untimely treatment of bedsores in patients can lead to serious consequences.

Such as:

circulatory disorders;
formation of gangrene;
sepsis;
cancer diseases;

Let's celebrate! Of course, such cases are extremely rare. But it must be remembered that there is still a risk, so maximum efforts should be made to overcome bedsores in the early stages of development.

Treatment of bedsores

Treatment is prescribed depending on the degree of damage to the body. Stage 1 and 2 bedsores can be treated at home. More complex cases with deep and purulent lesions require surgical intervention.

At stage 1 of bedsores you need to:

cleanse with camphor alcohol every couple of hours;
treat the skin several times a day with sea buckthorn oil;
keep the sore area clean and dry

It is important not to massage sore areas; even during treatment, it is not recommended to use any force. The skin in such places is very thin and can be easily injured, which can lead to infections.

Stage 2. At this stage, alcohol and oil alone will not help. It is necessary to add special medications.

treat the wound with chlorhexidine several times a day, it has an antiseptic effect;
After treatment, immediately apply a special ointment;
apply hydrogel bandages to sore spots;
use special applications that promote rapid wound healing. Hydrogel dressings and applications are expensive products, but their use significantly speeds up the healing process.

Stages 3 and 4. At these stages, significant wounds usually appear that require surgical intervention.

This is how it is done:

cleansing the wound and body area;
applying bandages with a healing effect;
if there is a large amount of pus in the wound, a special type of dressing, such as Biaten, is used. After the wound has dried, special medications can be applied to it.

Treatment at home

It should be remembered that treating bedsores at home must be done with extreme caution. At stages 1 and 2, wound treatment with Kalanchoe is allowed. The leaf is cut and tied to the wound. The juice of this plant removes harmful fluids from the wound, dries it and speeds up the healing process. Agave juice will also be a good helper. Compresses from it are applied to bedsores for 20-25 minutes.

Note! Potato starch is also used as a preventative measure. It removes excess moisture from the surface. Experts recommend treating the affected areas with sea buckthorn oil, since among all the listed drugs it has the best effect.

Prevention measures

When caring for bedridden patients, checking the condition of the skin is a mandatory procedure.

Particular attention should be paid to places that are prone to the formation of bedsores:

to prevent the formation of wounds, it is necessary to change the patient’s position every 2-3 hours, and it is important to do this with extreme caution in order to avoid unnecessary friction and stretching of the skin;
choose bedding and clothing from natural fabrics, preferably without buttons or other elements that could create a risk of skin damage;
maintaining the optimal temperature in the patient’s room. It should be neither low nor high;
the bed should be clean and dry. If necessary, use diapers or diapers.

Important to remember: that it is easier to prevent a disease than to deal with its complications later. Therefore, when caring for bedridden patients, it is necessary to pay attention to creating comfortable conditions for their life, observing the rules of hygiene, so as not to suffer from complications later.

Staying in bed for a long time slows down the body's metabolism, disrupts normal blood circulation and causes the formation of bedsores. The disease is accompanied by tissue necrosis and can be fatal. The initial stage of bedsores is a slight hyperemia and thickening of the skin. If preventive measures are not taken in time, the disease will begin to progress, causing excruciating pain to the person.

Causes of bedsores formation

First of all, you need to know how bedsores begin. For normal tissue nutrition, good blood circulation and access to oxygen are necessary. Bedridden patients are forced to remain in one position for a long time. In this case, bones and tendons put pressure on soft tissues and blood vessels, and natural blood flow is disrupted. Congestion can be reduced by the fat layer, but in an immobilized patient it becomes thinner. This is how the pathological process begins.

Another cause of soft tissue necrosis (necrosis) is impaired lymph and blood circulation. Problems with blood flow begin after just 2 hours of being stationary - in a sitting or lying position. In weakened patients, the pathological process can develop rapidly, so potentially dangerous areas must be constantly inspected. Bedsores also begin due to poor care for the patient when he has:

rare change of bed linen;
hard bed;
sloppily tucked sheets (creases, folds);
lack of body hygiene;
rare change of poses.

The following factors increase the likelihood of necrosis:

diabetes;
poor nutrition;
dehydration of the body;
bad habits;
increased sweating;
enuresis;
muscle spasms (involuntary movements).

Constant friction and sliding of body parts on the surface of the bed causes bedsores, the initial stage of which can quickly develop into tissue necrosis. When moving, the superficial layers of the skin shift relative to the deep ones. The epidermis becomes thin, the vascular walls become fragile. As a result, the smallest capillaries break, impairing blood supply. The same action occurs when they try to inaccurately pull out a sheet or blanket from under the patient, so it is necessary to carefully change the bed linen.

Main signs of bedsores

Bedsores develop in stages. According to the depth of tissue damage, 4 stages are distinguished: blood stagnation, damage to the epidermis, ulceration of the dermis and adipose tissue, deep necrosis to the bone.

How do bedsores begin in bedridden patients?

In the supine position, the bones put pressure on the soft tissues, as a result of which the vessels are compressed;
Staying in one position for a long time does not allow blood to circulate in areas of compression;
Numbness of the skin area occurs;
The blood cells remaining in the vessels give the skin a red tint, and over time it turns blue;
Fluid stagnates in the tissues;
The affected area thickens;
Moist bubbles form on the surface, which open, tearing the epidermis and the initial stage passes into the second.

Relatives must know what bedsores look like in the initial stages. The skin is red, thinned, rough due to the desquamation of keratinized particles. If you look closely, you can see micro cracks on its surface. The affected area is swollen and cold to the touch. After a few days, the surface of the epidermis becomes strewn with many moist bubbles; they gradually merge, forming a blister, which leads to detachment of the epidermis. When blisters appear, the patient complains of itching in the affected area.

Note. Skin hyperemia can quickly progress to the second stage of the disease with the addition of infection.

How to distinguish bedsores from other skin lesions

There are certain areas on the human body that experience the greatest pressure from bones on soft tissue. Bedsores begin on the back of the head, shoulder blades, elbows, sacrum, and heels. It is necessary to carefully examine these areas and, if redness is detected, begin active prevention and treatment. If a person has changes in the skin of a bedsore, the initial stage can be mistaken for bruises and diaper rash, which sometimes occur in bedridden patients.

Distinctive signs of bedsores from other skin lesions:

At the initial stage of formation, patients complain of tingling in compressed areas of the body and loss of sensitivity. An important distinguishing feature of a bedsore is the location of the damaged area above the protruding bone. Diaper rash most often occurs in the folds of the skin (in the groin, under the mammary glands).

If bedsores begin, it is necessary to take a number of measures to prevent necrosis. Doctors advise purchasing an orthopedic mattress, foam pillows and bolsters. It is necessary to turn the bedridden patient over more often and massage him.

Therapy

Treatment of initial bedsores is aimed at improving blood circulation, eliminating pressure on the problem area, and strengthening the immune system. At an early stage, preventive measures can be taken without the use of antibiotics. Local treatment of the initial stage of bedsores involves treating the affected area with creams and alcohol solutions. For these purposes the following is used:

2% camphor alcohol;
1% salicylic alcohol;
0.5% ammonia;
2% tannin solution;
Solcoseryl;
Bepanten and its analogues.

An incipient bedsore can be treated with medications containing silver (Dermazin, Sulfargin). They heal wounds, reduce burning and pain. The Algofin product has proven itself to be excellent. It contains an extract from algae, which activates regenerative processes. Creams and solutions are applied to cleansed skin 2-3 times a day for 2 weeks. At the initial stage of the disease, it is necessary to carry out immunostimulating therapy and give the patient vitamin complexes. Phentolamine is prescribed to dilate blood vessels and improve blood circulation.

Rules of care

What to do if bedsores begin is a common question for relatives faced with such a situation. In addition to medications, it is necessary to follow the following rules of care:

Keep the skin clean, let the patient take air baths more often.
Wipe oily skin with products containing alcohol, dry skin - moisturize with baby cream.
If the area of the epidermis is red, massage around it, increasing blood circulation.
For incontinence, use diapers and powder underneath.
Eliminate the consequences of excessive sweating with a solution of table vinegar.
Turn the patient over every 2 hours.
Ventilate the room and monitor the air temperature.

Daily care, medications and vitamins will help strengthen the immune system, improve blood circulation, and restore tissue trophism at the initial stage of the disease.

Folk remedies

Treatment of initial bedsores can be carried out with folk remedies. There are many recipes for improving blood supply to tissues and increasing the body's defenses. At the initial stage of the disease, you can use red rose oil. It has a bactericidal and healing effect. The reddened surface is lubricated with an oil swab.

Recipes for bedsores at the initial stage:

Cut an aloe leaf in half and apply it to the sore spot. You can use squeezed juice. The plant has a wound-healing effect and promotes tissue regeneration.
Grind the calendula flowers, mix a tablespoon of raw material with Vaseline. Lubricate the affected area 2 times a day.
Make a vodka infusion. Combine calendula and vodka in a 1:2 ratio. Leave for 2 weeks and wipe the problem area. You can install gadgets. Alcohol warms the skin and helps increase blood flow.
Steam the millet, put warm cereal in gauze and apply to the bedsore. The procedure improves blood circulation.

In addition to healing ointments and lotions, it is necessary to provide the patient with proper nutrition. Protein is required to build muscle mass. They are found in eggs, meat, dairy products, and nuts. Vitamins B and C are needed for tissue regeneration. It is necessary to include cereals, citrus fruits, and sweet peppers in the menu.

The initial stage of bedsores in bedridden patients responds well to treatment. It must be remembered that the development of the pathological process begins unnoticed and can quickly turn into necrosis, causing additional suffering to the patient. Treatment of an advanced form is long and expensive; its absence can cause gangrene and sepsis. Competent care, massages and special orthopedic devices help prevent bedsores and improve the patient’s condition.

Reading time: 11 minutes. Views 13.2k.

The concept of “bedsore” means the process of necrosis (necrosis) of the skin and deep-lying tissues (with progressive stages of the lesion). It develops due to prolonged constant pressure, accompanied by impaired blood circulation and innervation, on certain areas of the body.

Classification (stages)

Depending on the degree of development of the disease and the presence of lesions, four stages are distinguished:

This is the so-called dynamic classification, depending on the causes and factors that influence the development of the disease. Sometimes, with proper care and timely treatment, bedsores can be localized already in the first stage, and in some cases, very little time passes from the first to the fourth stage: the process develops rapidly, with an unfavorable prognosis for the patient.

Other signs by which bedsores are classified include:

Dimensions of necrosis:

less than 5 cm in diameter;
5-10 cm in diameter;
from 10 cm and more.

Structure of ulcerative formation:

presence of a canal (fistula);
the absence of a channel that connects the lesion on the skin with subcutaneous structures.

Development mechanism:

endogenous bedsores (neurotrophic nature or circulatory disorders); Occurs in patients with lesions of the spinal cord and other large structures of the nervous system against the background of a stroke or the presence of a tumor formation;
exogenous bedsores - against the background of prolonged compression (external and internal);
mixed bedsores (found in weakened patients).

Causes

The main reasons that lead to the development of bedsores are:

Constant pressure from the edges of bone formations on the soft tissues of the body. As a result, normal blood circulation (microcirculation in tissues) is disrupted, which leads to local ischemia of muscle fibers and subsequent necrosis (necrosis) of the affected areas due to lack of nutrition.
Changing the position of the body in bed (elevated head), when the center of gravity moves to the area of the sacrum and deep fascia. This leads to stretching of vascular bundles with the formation of blood clots and subsequently disruption of normal tissue nutrition and normal skin structure.
Friction of the skin against any hard surface or hard sheet, high humidity lead to damage to the outer protective layer of the skin.

Risk factors

In addition to the main reasons for the development of bedsores, one should take into account a number of predisposing factors that can “trigger” and accelerate the mechanism of formation of this pathology.

These include:

Restriction of movement within the bed. Relevant to post-operative patients, patients who are taking sedatives, are comatose, or undergoing treatment for injuries.
Concomitant pathology. The risk of pressure sores increases in patients with diabetes mellitus, atherosclerosis, Parkinson's disease, with general exhaustion of the body and the presence of neurological diseases, primarily with paralysis of the upper and lower extremities (paraplegia), when sensitivity is absent.
Disorders of urination and defecation (incontinence).
Poor, unbalanced diet and insufficient daily fluid intake.
Social factor. An insufficient number of junior medical personnel who serve bedridden patients often leads to the patient not receiving proper care. This is especially true for males over 75 years of age (the main risk group for the development of bedsores).
Bad habits (for example, smoking) that provoke spasm of blood vessels.

Localization

The location of pressure sores depends on the position of the patient in bed or in a wheelchair.

When lying on your back for a long time, bedsores most often develop in the area of massive bone structures - the pelvic bones, the sacroiliac joints.

In the projection of the skull bones (occipital bone), the area of the shoulder blades and calcaneus, skin lesions are also possible, but are much less common.

If the patient is forced to lie on his side, the first place where there is a risk of developing bedsores is the area of the hip joint (greater trochanter of the femur) and the temporal region. Do not forget about the areas of the knee and shoulder joints, the auricle, where the development of pathological changes is also possible.

When lying on your stomach, you need to pay attention to the projection of the iliac wing onto the skin. It is in this place (on both sides) that pathological changes characteristic of this disease most often appear.

If the patient is forced to move in a wheelchair, you need to pay attention to the places that come into contact with this vehicle - the spine, buttock and sacral areas, elbow joints.

Symptoms

The main sign that requires special attention when caring for a bedridden patient is the appearance on the skin (in places of pressure from the bones) of hyperemic areas with a characteristic shine.

The overall clinical picture depends on the stage of the process. At initial manifestations, slight soreness on the skin, a feeling of numbness and redness are noted. If preventative measures are not taken, a bedsore can quickly develop into more severe phases, when areas of necrosis with an unpleasant odor (wet necrosis) and signs of general intoxication of the body appear - high temperature, confusion, rapid heartbeat, etc.

Diagnostics

Making a diagnosis is not difficult due to the characteristic clinical picture that is inherent in each stage of the disease. Special diagnostic methods are not used, with the exception of wound culture to determine the type of pathogen and prescribe appropriate treatment.

In case of intoxication and the threat of developing sepsis, diagnostic methods characteristic of infectious diseases are used - monitoring blood parameters (leukocytes, ESR), urine (protein), water-salt metabolism and homeostasis.

Complications

The most serious complication is general infection with pathogenic organisms (sepsis).

Local complications primarily relate to damage to bone structures, muscle pockets and articular components. When bedsores appear (especially with the formation of a necrosis zone and the formation of a fistula), diseases such as osteomyelitis (contact), arthritis (purulent), and phlegmon can develop.

If blood vessels are involved in the process, there is a risk of local bleeding due to melting of the vessel walls as a result of inflammation.

Treatment

Complex therapy for bedsores is aimed at:

to eliminate pressure on the affected soft tissues and skin, eliminate other factors causing bedsores;
for local treatment of skin lesions and subcutaneous formations;
to eliminate the causes and symptoms of the underlying disease, which led to the forced position of the patient in bed.

At the first signs of the development of the disease (changed skin color), it is necessary to remove the pressure on this area: using an inflatable ring or by shifting the patient. The affected area is washed with cold water and treated with camphor alcohol.

In the first degree, surgical treatment is not prescribed; it is important to prevent the development and aggravation of the process. The risks of progression of the lesion must be eliminated, and skin treatment should be aimed at protecting against infection.

In parallel with this, treatment is carried out for the disease that causes bedsores (for example, diabetes mellitus or severe trauma).

The main goal of treatment and prevention of bedsores is to eliminate the constant pressure on certain areas of the skin. Changing the patient's body position during bed rest every 2 hours completely eliminates the risk of developing lesions.

To help patients and medical staff, products have been developed to reduce pressure and its constant effects: special mattresses; beds; gaskets, pillows, etc. filled with water, air or helium. Systems with the ability to regulate it and a vibration function facilitate the weakening of pressure at certain time intervals.

Local therapy includes careful treatment of the area of skin with a developing pressure ulcer. A clean ulcer or inflamed skin surface is treated with saline solution and dried thoroughly.

Use agents that stimulate local blood circulation. At this stage of the disease, the use of drugs with ion-exchange properties (chlorhexidine, hexachlorophene, etc.) is inappropriate. By disrupting the permeability of cell membranes, they reduce their ability to resist bacteria.

Transparent films (made of polyurethane) have protective and antibacterial properties. They protect damaged skin from bacteria (thanks to small pores) and have excellent ventilation properties. The transparent layer allows you to constantly monitor the condition of the affected area.

The second stage is considered as transitional. At this stage, small areas are affected, the ulcers are superficial. There is no need for surgical intervention.

When changing dressings, carefully clean the wounds:

It is necessary to remove the top layer of skin (epidermis) when blisters form. Transparent films, gel, foam dressings, etc. are applied to the surface without epidermis. Special control and “monitoring” of this area is necessary before the formation of a new epithelial layer. At the first signs of an inflammatory process, antibacterial treatment is carried out, and dressings are changed more frequently.
General contamination is eliminated.

The third degree is characterized by the appearance of a necrotic process affecting the deeper layers of the skin (fatty tissue up to the fascia is affected).

Complex of therapeutic procedures:

Necrosis is removed by surgery.
The wound is cleansed of purulent contents and remnants of dead tissue (necrosis). Treatment involves the absorption (absorption) of toxic products.

The skin must be protected from drying out during the recovery period.

Necrectomy and removal of pus must be carried out as quickly as possible. Areas affected by wet necrosis quickly expand, especially to areas with impaired blood supply. Such surgical intervention promotes rapid healing of bedsores and general detoxification of the body.

Dry necrosis practically does not occur: under the scab, as a rule, wet and purulent fusion is found. With such a mixed form of lesion, the use of sequential necrectomy is most effective.

The main goal of postoperative treatment is to relieve the inflammatory process.

Apply:

antibacterial (fungicidal and bactericidal) agents of local action;
dehydrating drugs;
anti-inflammatory;
means that stimulate reparative (restorative) processes;
drugs that improve endothelial function.

Such complex treatment relieves the septic condition and clears the ulcer.

In case of a pronounced “weeping” wound, the affected area is isolated with foam bandages. When there is a small amount of discharge, hydrogel dressing materials are used.

The fourth stage is characterized by necrotic damage to deep subcutaneous tissues: muscle, bone, joint. After surgical removal of necrosis, complex treatment of the affected surface is necessary: absorption and simultaneous correct hydration of the wound.

At this stage, excision of all necrotic areas is almost impossible due to the difficulty of determining the boundary of the damage. During surgery, the surgeon must remove dead tissue in the area of the joint capsules and neurovascular bundles as gently as possible.

When carrying out surgical treatment, a preliminary assessment of the condition of the affected area and determination of the nature of the upcoming surgical intervention is of great importance. Incorrect treatment can lead to an increase in the area of ulcerated skin and the occurrence of postoperative complications.

In addition to complex treatment (similar to therapy for the third degree), the following antimicrobial methods are used after surgery:

ultrasonic treatment;
UHF thermal procedures;
phonophoresis (with antiseptic agents);
electrophoresis (with antibiotics).

To increase the regenerative abilities of soft tissues, use:

low intensity laser radiation;
mud applications;
direct current stimulation;
electroacupuncture.

If the prescribed methods of conservative treatment do not contribute to the healing of a deep ulcer (by at least 30 percent in area) within 2 weeks, the tactics of the therapy used are reviewed.

Prevention

When caring for seriously ill patients, it is necessary to check the condition of the skin every day, focusing on protruding areas (in areas of greatest pressure).

The set of preventive measures includes:

Changing the position of a bedridden patient (at least every 2-3 hours). Turning and shifting must be done with the utmost care, avoiding excessive tension and friction of the skin.
Room temperature regulation. Too low a temperature will cause hypothermia, a high temperature will cause diaper rash due to increased sweating. It is in constantly moisturized areas of the skin that the risk of developing bedsores increases sharply.
Bed linen and clothing should be made from soft natural fabrics. Hard fasteners, buttons and fastenings on clothing can cause lesions on the skin with increased stress (friction and pressure).
Bed linen and home clothes should be clean (to prevent skin infection) and dry. It is recommended to use moisture-absorbing hygiene products (diapers, diapers, etc.). Bed linen should be changed in a special way: the patient is rolled onto a clean sheet, gradually removing the dirty one. Under no circumstances should you pull out your underwear.
Gentle and gentle care for the skin of bedridden patients involves the use of hypoallergenic products for sensitive skin that do not contain alcohol or other aggressive components.
Wet skin must be wiped and dried with a soft towel, and contaminated areas (from feces, urine) must be cleaned in a timely manner.

If possible, stimulate the patient’s physical activity and carefully plan the diet. The menu should include foods high in vitamins and microelements; the amount of high-calorie, fatty foods must be limited: in addition to excess weight, its consumption is fraught with metabolic disorders.

Which doctor treats

When signs characteristic of bedsores appear, the attending physician of the underlying disease (therapist, endocrinologist, oncologist, traumatologist or surgeon) takes steps to prevent the development of more severe forms of skin lesions.

If it is not possible to avoid the progression of the disease, the main role is assigned to purulent surgeons for radical treatment, infectious disease specialists to fight the infection, and toxicologists (and sometimes anesthesiologists) to relieve intoxication and its complications.

If complications of bedsores appear, specialized specialists get to work, depending on the etiology and genesis of the complication.

– these are areas of the skin that are damaged due to tissue compression due to prolonged contact with the surface. For example, forced, as a result of illness, to be in a wheelchair, a special splint for a fracture, or lying on a bed. In such cases, tissues receive a small amount of blood and die.

Causes of bedsores.

The entire human body is intertwined with blood vessels and capillaries. Thanks to them, oxygen saturation and nutrition of tissues occurs. The smallest capillaries penetrate every centimeter of the skin. If for some reason there is prolonged compression of the vessels, then enriched blood does not flow to this place. As a result, the tissues lack nutrition and die. This is why bedsores form.

Sometimes in bedridden patients, the upper skin is displaced, which also leads to the formation of bedsores. When caring for such patients, it is often necessary to change wet bed linen and simply pull it out from under the bed. Or they drag a seriously ill patient across the bed trying to move them. All this can lead to skin injury and bedsores.

Risk of developing bedsores.

All bedridden patients are at risk of developing bedsores. But the likelihood of their occurrence in people who are overweight, or, conversely, severely malnourished, with diabetes, and prone to excessive sweating, is much higher than in others. Patients with cardiovascular diseases, spinal cord and head injuries, as well as those who have problems with fecal and urinary incontinence are at risk. Unfavorable living conditions and insufficient care for such patients can also cause bedsores. If the skin is dirty, and there are unevenness, folds, foreign small objects and crumbs in the bed, or an allergic reaction to care products, all this increases the chances of bedsores forming.

Places of formation of bedsores.

Parts of the body that touch the surface tightly and have a bony prominence are the most common places for bedsores to form. Where there is a bony protrusion, there is almost no fatty tissue under the skin, which reduces pressure on the tissue.

The formation of bedsores largely depends on the position of the patient's body when lying down.

So, if the patient is forced to lie on his back a lot, bedsores will appear on the ischial tuberosities, shoulder blades, sacrum, back of the head, as well as elbows and heels.

If the patient constantly lies on his side, bedsores occur on the hips, ankles and knees. If you have to lie on your stomach, bedsores form on your cheekbones and pubis.

Degree of severity of bedsores.

Medicine distinguishes six stages of bedsores, according to their severity.

Bedsores - stage 1 is characterized only by redness of areas of the skin, which are compressed for a long time.

Bedsores - stage 2 - swelling of the skin is noted, blisters appear, and necrosis of the upper skin begins.

Bedsores - stage 3 - ulcers appear in place of the blisters.

Bedsores - stage 4 - the ulcers become deeper and affect the skin, as well as the muscles.

Bedsores - stage 5 - the affected muscles also die.

Bedsores - stage 6 - the degree of damage is very severe, the ulcer penetrates to the bone. The bone also becomes damaged and infected.

Treatment of bedsores.

It is easier to prevent bedsores than to treat them later. There is no magic cure that will help you cope with this disease. It is only necessary to carry out a number of measures to restore blood circulation and eliminate tissue compression in the place where the bedsores appeared. By taking preventive measures, you can stop the development of bedsores. To heal existing bedsores, it is good to use Iruksol ointment, as well as bandages made of gauze soaked in Vaseline. Also in the pharmacy chain there are specialized hydrocolloid dressings that promote rapid healing. Their significant drawback is the price. The choice of various healing ointments is large. Sea buckthorn oil helps a lot. In the event of a bacterial infection, it is important to use antibacterial drugs.

Large areas of bedsores that are difficult to heal are treated with surgery, namely tissue grafts.

Prevention of bedsores.

The main goal of preventive measures is to prevent compression of tissues and disruption of their circulation.

First of all, good care for a bedridden patient is required. It would be good if it was a patronage specialist. In order to prevent tissue compression, you should put a soft but fairly elastic mattress on the bed. Today there are special mattresses for bedsores on sale. They perform the function of massage and help improve blood flow in tissues. A good effect is achieved by using a foam mattress if it is not possible to purchase a special one. The position of the supine body should be changed as often as possible. But this should be done carefully so as not to injure the skin. It is necessary to carefully monitor the cleanliness of the bed, which should be smooth, not crumpled, free of crumbs, clean and dry. Those areas of the body that are more susceptible to the formation of bedsores must be raised by placing cushions or pieces of foam rubber under them. A rubber circle can be placed under the sacrum. All these designs help to increase the area that comes into contact with the bed. As a result, blood flow in the tissues improves and the likelihood of developing a bedsore decreases.

A bedridden patient should be moved with care in bed to prevent injury to soft tissues. If it is impossible to move or turn the patient on your own, get someone to help. If you need to change bed linen, first lift the patient and then pull out the sheet. All patient care operations must be performed carefully and accurately.

To prevent skin irritation, all underwear should be soft. All products used to care for the patient’s skin must be hypoallergenic. Toileting intimate areas should be done frequently, because urine and feces are the main irritants of the skin. You should also monitor the temperature in the room and dress the patient accordingly to prevent overheating and diaper rash.

Thus, the prevention of pressure ulcers depends on the quality of care. Today there are a lot of cosmetics on the market designed to make caring for such patients easier. If necessary, use diapers, various creams and powders, and special drying ointments. The skin should be kept clean and dry and should not be over-moistened. All care devices should be as soft as possible and not injure the skin.