Let's learn about pressure injuries in bedridden people. (Pressure Injuries / Bedsores)

Is there anyone in your family who is confined to bed due to illness or old age and stays in the same position for a long time? You must have seen that such people sometimes develop skin wounds. We call these "bed sores". Medically, these are known as `(Pressure Injuries)` or `(Bedsores). Today, we will talk in detail about what these really are, why they occur, how to prevent them, and what to do if they occur again . This is an important topic for many people.

What exactly are these bed sores?

Simply put, bedsores are wounds that develop when there is pressure on the same area of ​​our skin for a long time, causing damage to the skin in that area. Imagine, when someone stays in bed for hours or days in the same position, or when they sit in a wheelchair for a long time in the same position, the skin presses against the bones in the places where the body's weight falls. When this pressure is applied, blood circulation is reduced. If the blood does not flow properly, the skin cells start to die , and that is when these wounds occur.

There are other names for these bedsores. Your doctor may use these names:

• `(Decubitus ulcers)`
• `(Pressure sores)`
• `(Pressure ulcers)`
• `(Pressure wounds)`

No matter what name you call it, it means the same situation.

How common are these bed sores? Who gets them most often?

This is actually more common than you might think. This risk is especially high for those who have difficulty moving around on their own, are confined to bed, or use wheelchairs. Imagine if one of our grandparents is bedridden due to illness, or if someone has a condition like ``Paralysis`` due to an accident and is confined to bed, they are more likely to develop these injuries.

Also, people with certain medical conditions are at higher risk. For example:

• For those with `(Diabetes)`
• For those with reduced skin sensitivity
• For those with nutritional deficiencies (Malnutrition)
• For those with very dry skin or those who retain too much moisture
• For those who are unable to communicate their difficulties due to conditions such as `(Dementia)`
• Some cancer patients
• For children and adults with neurological diseases such as cerebral palsy
• `(Chronic venous insufficiency)` (Poor blood circulation in the veins)
• `(Heart failure)` (Heart failure)
• `(Kidney failure)` (Kidney failure)
• Peripheral artery disease (narrowing of the arteries that supply blood to the limbs)
• Conditions such as spinal cord injury or spina bifida.

Where on the body do these wounds occur most often?

In fact, these wounds can occur anywhere on the body. For example, someone using an oxygen mask can get wounds on the top of their nose, on either side of their ears, or on the back of their head. Someone wearing a poorly fitting denture can also get these wounds inside their mouth. Also, if someone has been intubated (putting in a breathing tube) or is being given mechanical ventilation (breathing with the help of a machine), the associated pressure can cause wounds.

However, these injuries are most common in areas where the bones are close to the skin . This is because those areas are where the skin is pressed against the bone and blood flow is reduced. Such areas include:

• Ankles
• Back
• Buttocks
• Elbows
• Heels
• Hips
• Tailbone (bottom of the spine)

What are the causes of bed sores?

The main reason is, as I said before , pressure on the same spot for a long time . Due to this pressure, the small blood vessels that supply blood to the skin are squeezed, and it is as if the blood does not flow. Imagine, when you squeeze a water pipe and hold it tightly, the water does not flow. When this blood is lost, the cells of the uppermost layer of the skin `(Epidermis)` start to die. When these dead cells break down little by little, they appear as a wound. Sometimes , even if you have been pressed in the same place for a short time, like two hours, a wound can start .

In addition to this pressure, other things contribute to the formation of these wounds:

• Moisture: If the skin is wet due to things like sweat, urine, and feces, it becomes even weaker and more susceptible to injury.
• Traction/Shear: The skin is pulled when the head of the bed is raised, when the body is in a wheelchair, or when the body slides down. This pulling can also damage the tissues underneath the skin and cause wounds.

What are the symptoms and stages of bed sores?

The symptoms of bed sores can vary from person to person. Some people may feel pain and itching from these sores. However, people with weakened nerves and reduced sensation may not feel this pain. Therefore, it is very important to check the skin regularly.

Doctors classify these bedsores into stages based on their severity. This helps determine how to treat the wound.

• Stage 1: The skin appears red or pink. However, there is no skin break or wound yet. This color change may be a little difficult to detect for someone with dark skin. The area may feel a little sore to the touch, or it may feel hotter, colder, softer, or harder than other areas.
• Stage 2: This is where the top layer of skin has been removed, leaving a shallow wound with a pink or red bottom. You may also see skin peeling and blisters .
• Stage 3: The wound is now a little deeper. The wound may have spread all the way down to the hypodermis, the fatty layer under the skin.
• Stage 4: This is the most severe stage. The wound has penetrated all three layers of skin, and the underlying muscles, tendons, and possibly even bones (the musculoskeletal system) are visible. These types of wounds take a long time to heal, and they are more likely to cause complications.

What are the possible complications of bed sores?

Bed sores are not just skin wounds. If left untreated, they can lead to life-threatening bacterial infections .

These wounds can lead to dangerous conditions such as `(Cellulitis)` (infection of the skin and underlying tissues), `(Septicemia)` (blood poisoning). Sometimes, it can progress to `(Sepsis)` (a severe infection that spreads throughout the body) and even `(Amputation)`.

Some people develop sinus tracts that lead from these bedsores. If these tracts connect to deeper parts of the body, problems such as:

• Bacteria entering the bloodstream (Bacteremia). This can cause bacterial meningitis (infection of the brain) or endocarditis (infection of the lining of the heart).
• Bone infections (Osteomyelitis) or joint infections (Septic arthritis).
• Bacterial infections such as `(Group A streptococcus)`. These can range from a common infection like `(Cellulitis)` to a dangerous condition called `(Necrotizing fasciitis)` (flesh-melting disease).

How do you know if a bed sore is infected?

If a wound becomes infected, you may experience symptoms such as:

• Fever and chills are often the first symptoms to appear.
• Feeling severe pain at the site of the wound.
• A bad smell coming from the wound.
• The wound is red and feels very hot to the touch .
• Wound swelling .
• Pus draining from the wound.

If you see something like this , it is very important to seek medical advice immediately .

Bed sores diagnosis and treatment

If you suspect that you or someone you care for has a bed sore, you should see a doctor. You may also need to see a wound specialist. Doctors will look at the appearance of the wound to determine if it is a bed sore and what stage it is in. They may also take pictures of the wound to see how it is healing.

You can also do tests like these to check for infections:

• Taking a small piece of the lesion for examination (biopsies).
• Blood cultures and tests.
• Scans like `(X-rays)` or `(MRIs)`.

Nonsurgical treatments

Mild wounds in stages 1 and 2 can often be treated at home by you or your caregiver (with medical advice). Deep wounds in stages 3 and 4 require medical attention. Depending on the severity of the wound, healing can take weeks to months .

The following are the treatments:

• Cleaning the wound: Clean the wound with either soapy water or saline (sterile saltwater solution).
• Dressing the wound with medicine: There are special types of medical bandages that help the wound heal faster. Examples include Hydrogel (water-based gel), Hydrocolloid, Alginates (made from seaweed), and foam dressings.

In deep, severe wounds, the doctor will remove the dead tissue. This is called ``Debridement.`` This is done by cutting away the dead skin with a sharp instrument ``Scalpel.`` Or, they may apply ointments that dissolve the dead tissue and remove it. When this is done, a ``Local anesthetic`` may be injected to numb it. Because the tissue around the dead tissue feels pain.

Medications given

Depending on the condition of the wound and symptoms, the following medications may be given:

• Antibiotics prevent and treat infections.
• Reduce pain and swelling (Nonsteroidal anti-inflammatory drugs - NSAIDs)
• Pain relievers.

Surgical treatments

For very deep, large wounds in stages 3 or 4, surgery may be necessary. A skin graft may be used to close the wound and help it heal more quickly.

How to prevent bed sores? This is the most important thing!

It's much easier to prevent bed sores before they occur than to suffer from them after they occur. Here are some things you can do about them:

• Change your position frequently: If you are in a wheelchair, change your position at least every 15 minutes . If you are bedridden, turn your body around at least every two hours . If you are having trouble doing this on your own, get help from a caregiver. This is the most important thing.
• Regular skin checks: Check your skin all over your body (especially pressure points) at least once a day. Check for changes in color, pain, heat, or coldness. If you can't do it yourself, have someone else do it.
• Eat well and drink plenty of water: Eat nutritious foods, especially protein-rich foods, to keep your skin healthy. Drink plenty of water throughout the day.
• Keep the skin clean and dry: If sweat, urine, or feces get on the skin, clean it immediately and keep it dry. You can use moisture barrier creams to protect the skin.
• Exercise: Exercise as much as possible. This improves blood circulation. You can seek advice from a doctor about physical therapy.
• Avoid smoking: If you smoke, seek help to quit. Nicotine delays wound healing.
• Use special mattresses and cushions: Use specially designed mattresses or foam cushions that are designed to reduce pressure. Avoid sitting on cushions that have a hole in the middle, like a donut. This can increase pressure around the wound.
• Wash and change bedding, underwear, and clothes frequently: It is very important to keep these clean.

Outlook for someone with bed sores

Even after a bed sore heals, the skin in that area is not as strong as it was before. That's why it's important to continue to follow steps to prevent reoccurrence . Severe bedsores in stages 3 or 4 are harder to heal, and they're more likely to become infected and have a higher risk of life-threatening complications.

When should you see a doctor?

If you are at risk of developing bed sores and notice any of these symptoms, tell a doctor immediately:

• Skin discoloration (red, pink, purple).
• Signs of infection (fever, swelling, pus, bad odor).
• If it hurts or feels hot when you touch a certain area of ​​your skin.

Questions to ask your doctor

• Why did I get this bed sore?
• What treatment is best for me?
• Do I need surgery?
• What can I do to prevent bed sores?
• Should I be concerned about complications?

Bed sores and the importance of nutrition

Many people who develop bedsores are malnourished. This can be caused by aging or other medical conditions. Eating a nutritious, protein-rich diet can help prevent bedsores and help wounds heal more quickly. Vitamins and supplements may also be needed. Rarely, people with severe malnutrition may need to be given food through a tube (enteral nutrition) or intravenous nutrition (IV nutrition).

Finally, things to remember (Take-Home Message)

People who are immobile, bedridden, wheelchair-bound, or have other risk factors are at higher risk for developing bed sores. Therefore , it is essential to follow preventive measures such as regular skin checks and changing positions. (If you can't do it yourself, get help from a caregiver, family member, or health care provider.)

It is best to identify bed sores early (stages 1 and 2). Then, they can be treated before the skin breaks and the wound gets bigger. Early wounds like these heal better with treatment. However, deeper wounds (stages 3 and 4) are more likely to develop infections and other serious conditions. Therefore, it is important to seek proper medical attention.

If you or a loved one has any further questions about this, don't hesitate to talk to your doctor. Stay healthy!

` Bed sores, pressure sores, skin wounds, bedridden patients, immobility, skin care, wound healing