Pressure sores (LDD), also called pressure ulcers, are areas of injury to the skin, underlying tissues or both of these structures, caused by prolonged pressure on the skin which causes a temporary interruption of blood supply to the skin . LDDs tend to occur in regions where bony prominences are found and therefore pressure on the skin can be more concentrated.
Traction also reduces cutaneous blood flow. For example, traction occurs when people are placed on an inclined plane (as if they are seated on an inclined bed) and their skin is stretched. The muscles and tissues under the surface layer of the skin are pushed down by gravity, but the surface skin layer remains in contact with the external surface (such as the sheets). When the skin is stretched, an effect very similar to that of pressure is obtained.
Friction (rubbing against clothing or bedding) can cause, or worsen, pressure sores. Repeated friction can remove the superficial skin layers. Such friction of the skin can occur, for example, if the body is repeatedly pulled to be accommodated on the bed.
Moisture can increase the friction of the skin and weaken or damage its protective outer layer, if the skin is exposed to moisture for a long period of time. For example, the skin may remain in contact with sweat, urine (due to urinary incontinence) or feces (due to faecal incontinence) for a prolonged period.
To identify treatment plans best suited to each
possibilities, the LDDs are divided in four stages:
Stage I: redness of the skin that does not
disappears at acupressure. The skin is red or pink but it is not
open. The area can also be warmer, colder, firmer, softer
or more painful than adjacent surfaces;
The reduction of tissue compression is achieved through correct patient positioning, protective devices, and the use of support surfaces. The frequent change of position (and the choice of the most suitable position) is of utmost importance. Protective padding such as cushions, foam wedges, and heels can be placed between the knees, ankles, and heels when patients are supine or on one side. In patients immobilized by fractures, fenestrations must be cut in the plaster casts in the points subjected to pressure. Patients who are able to sit in a chair should be provided with soft cushions.
There are numerous types of dressings for the treatment of pressure sores. In all cases the main objectives
– cleaning and bandaging the wound;
Sometimes it is necessary to seek help from surgery
to promote deep cleansing of wounds.
To reduce pressure on the skin, patients should be carefully positioned and assistant should use devices of protection and prevention on the surfaces. In the early stages the injuries
usually heals spontaneously when pressure is removed.
For healing, lesions must be cleaned and flushed with
a saline solution or with disinfectants depending on the evaluation of the inflammatory state. After cleansing you can run the dressing. Dressings are used to protect the ulcer and promote healing. If the skin is
torn, a doctor or nurse will assess the location and status of the plague to recommend right type of dressing. The amount of drainage that exudes from
sores helps to establish the most suitable type of dressing.
A highly specialized type of dressing for deep wounds that generate large quantities of exudate is Topical Negative Pressure Wound Therapy (NPWT). Negative Pressure Therapy collects high volumes of exudate and therefore decreases the frequency of dressing changes and therefore exposure of the wound to the environment. Kinetic concepts such as suction that promotes tissue regeneration, microdeformation, increased perfusion and removal of infection and exudate may also intervene. Although there is no scientific evidence that indicates negative pressure dressing for the healing of pressure ulcers as “indispensable”, this therapy is used whenever it becomes available because it guarantees better wound cleaning and elimination of bad odor factors that contribute to greater patient comfort. In recent years, the healthcare costs of using the pumps for negative pressure bedsore therapy have increased by 600% in 6 years from 2001 to 2007.
Guidelines for Preventing and Treating Bedsores from the American College of Physcians (https://www.acponline.org/acp-newsroom/american-college-of-physicians-releases-new-guidelines-forpreventing-and-treating-bedsores)