Dr YLM
ANN/THE STAR – Bedsores are also known as pressure sores or pressure ulcers. They can also be called decubitus ulcers (decubitus means lying down).
Bedsores don’t only develop if you lie down in one position for a long time; they can also develop if you sit in one position for a long time. They are actually skin and underlying tissue injuries as a result of prolonged pressure on a certain part of your skin.
CAN A HEALTHY PERSON DEVELOP A BEDSORE?
Usually no. If you are healthy, you would be up and about, and tired of sitting or lying in one position all the time.
People who develop bedsores usually have underlying medical conditions that disable them from moving around. They have to spend most of their time sitting on a chair or lying down, and are unable to change positions.
These people are usually dependent on others to change their position.
Many times, they have difficulty communicating and cannot speak easily to express their pain.
For example, people who have had a stroke or advanced dementia, or people in a prolonged coma or who have suffered a fracture and had to wear a plaster cast for a long time. It is even worse if the patient has no caregiver to keep turning him or her.
Patients who did not receive proper nutrition due to being unable to eat, or neglect, also have it worse.
Any disease that impairs blood circulation to the skin, such as diabetes, also confers a higher risk of bedsores developing.
CAN A BEDSORE DEVELOP ANYWHERE?
Bedsores usually develop on pressure points, especially on skin that covers bony areas, like the hips, back or sides of knees, tailbone, heels, ankles, back of the head, shoulder blades – basically, any equipment or furniture a person spends a lot of time lying or sitting on.
WHY DO BEDSORES DEVELOP?
Bedsores develop when blood supply to your skin is cut off for over two to three hours (Yes, even hours matter).
That is why for some prolonged surgical procedures, the anaesthetist ensures that you get gel pads on pressure areas.
First, the impacted skin dies. Then, the skin and tissue turns into a red, painful area which may turn purple. If this is not treated, your skin can break open and be infected by bacteria.
THE FOUR STAGES OF BEDSORES
– Stage 1: The whole area looks red and feels warm to touch (inflammation).
For people with dark skin, it may look like there is a blue or purple tint to the area.
They may complain that the area burns, is painful or itchy.
– Stage 2: The area looks even more damaged and may have an open sore or blister.
It becomes very painful now.
There is discolouration on the skin around the wound.
– Stage 3: There is a crater now because the tissue underlying the skin is damaged.
– Stage 4: The whole area is severely damaged and the wound is large.
You may be able to see exposed muscles, tendons, bones and joints.
There is a high chance the area has been infected.
There is also a type of unstaged bedsore wound where there is full-thickness tissue loss.
However, the base of the ulcer is covered by slough instead.
CAN YOU TREAT A BEDSORE?
Yes, of course. First, the doctor or surgeon has to reduce the pressure and friction on the sore. The patient has to be repositioned often.
You also need good and special mattresses and seating cushions to help you sit or lie down and to protect your skin.
If it has progressed to a wound, it will have to be cleaned and dressed.
A bandage will also speed healing because it is a barrier against infection and wetness.
If the bedsore has gone on to Stage 3 or 4, then you need to remove the damaged tissue.
This procedure is called debridement, and is best done in a surgical theatre.
Infected bedsores need to be treated with antibiotics.
If the crater of the bedsore is too large, you may require plastic surgery to pad it up.
This is done by removing a section of your muscle or skin tissue from elsewhere to become a flap for the area.
