Decubitus, also known as bed sores or pressure ulcers, are areas of the skin, the underlying tissues, or both, that are injured. Decubitus ulcers can be painful, are prone to infection, smell bad and can affect patients’ quality of life.
People at risk of developing decubitis ulcers include: the elderly, those who are bedridden for long periods of time, people with spinal cord injuries and sometimes people who remain seated for long periods of time in a static position. The social cost of decubitus ulcers is very high, reaching a level of 4% of public spending in some countries.
A large study of hospitalised patients revealed a prevalence of decubitus of 10.5%, reaching a level of 26% for long-term patients. Decubitus ulcers should be prevented in the first place by frequently moving patients who cannot move independently. When decubitis ulcers occur, they must be treated quickly.
Decubitus ulcers are divided into different stages in order to better define the therapies to be applied.
- Stage 1: Skin still intact with redness that does not turn white when pressed against a bone surface. The area is usually sore, solid, soft and warmer in temperature than adjacent areas.
- Stage 2: Partial thickness. There is a shallow open injury and the bottom of the wound is pinkish, without secretions. It can also present as a blood blister. No bruising is apparent. This stage is not to be confused with skin tears, patch injuries, burns or incontinence dermatitis.
- Stage 3: Full thickness. The subcutaneous fat can be seen, but bones cannot. Tendons and muscles are exposed. There might be secretions, but the depth of the wound can still be determined. There might be possible sub-processes and tunneling.
- Stage 4: Full thickness with exposure of the bones, tendon and muscles. There might be secretions and eschars. There is often subduing and tunneling.
Over the years, many useful therapies have been used to address decubitus ulcers, such as dressings, creams and weight redistribution. Only more recently has negative pressure therapy been utilised. NPWT is implemented by first debriding and cleaning the wound, then placing a back sponge in the wound under gentle suction. The liquid produced by the wound is aspirated and collected in a container. Negative pressure therapy collects high volumes of exudate, thereby reducing the frequency at which the dressings have to be changed, while also reducing the exposure of the wound to the outer environment.
Kinetic concepts such as suction-encouraged tissue regeneration, microdeformation, perfusion augmentation and removal of infection are correlated benefits.
Possible side effects are wound maceration and retention of the wound’s dressing material (sponge), which could cause infection.
While there is no scientific evidence that suggests that negative pressure dressings are indispensable for ulcer healing, this therapy is always used when it is available for its guarantee of better wound cleaning and the elimination of foul odor, which contributes to creating greater comfort for the patient.
In the span of six years, from 2001 to 2007, the health care costs for negative pressure therapy pumps have increased by 600%. Although there are less expensive systems, many secondary facilities have difficulty finding the material and medical devices necessary to perform this kind of therapeutic intervention.