Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure.
Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas.
The diagnosis is usually based on a physical examination.
Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery.
Pressure sores can occur in people of any age who are bedbound, chairbound, or unable to reposition themselves. They are more common among older people. They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object .Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing.
Causes that contribute to the development of pressure sores include:
Pressure on skin, especially when over bony areas, reduces or cuts off blood flow to the skin. If blood flow is cut off for more than 1 or 2 hours, the skin dies, beginning with its outer layer (epidermis). The dead skin breaks down and forms an open sore (ulcer). Most people do not develop pressure sores because they constantly shift position without thinking, even when they are asleep. However, some people cannot move normally and are therefore at greater risk of developing pressure sores. They include people who are paralyzed, comatose, very weak, sedated, or restrained. Paralyzed and comatose people are at particular risk because they also may be unable to move or feel pain (pain normally motivates people to move or to ask to be moved).
Traction also reduces blood flow to the skin. Traction occurs when the skin is stretched by being wedged against something or when it sticks to something, often bed linens. When the skin is stretched, the effect is much like pressure.
Friction can lead to or worsen pressure sores. Repeated friction may wear away the top layers of skin. Such skin friction may occur if people are pulled repeatedly across a bed.
Moisture can increase skin friction and weaken or damage the protective outer layer of skin if the skin is exposed to it a long time. For example, the skin may be in prolonged contact with perspiration, urine, or feces.
Inadequate nutrition increases the risk of developing pressure sores and slows the healing process of sores that do develop. Malnourished people may not have enough body fat to pad the skin and bones or to keep the blood vessels from being squeezed shut. Also, skin repair is impaired in people whose diets are deficient in protein, vitamin C, or zinc.
For most people, pressure sores cause some pain and itching. However, in people whose senses are dulled, even severe sores may be ...