What is bedsore treatment? stage of healing of deep bedsores

– this is necrosis of soft tissues that occurs as a result of disruption of their nutrition and prolonged pressure on a certain area of the body. The development of pathology is facilitated by the patient’s limited mobility, insufficient care, and impaired sensitivity and trophism. Bedsores usually occur in areas where bony protrusions adhere to the skin (sacrum, heels, shoulder blades). Treatment tactics depend on the depth and stage of necrosis. For superficial bedsores, dressings are performed; for deep lesions, excision of dead tissue is necessary.

Treatment of bedsores

Treatment of all lesions, even small and superficial ones, should be carried out with the participation of a doctor. Self-medication is unacceptable, since this approach may further progress the pressure ulcer and develop severe complications. The basic principles of treating bedsores include restoration of blood flow in the damaged area, measures to promote the rejection of necrotic masses and wound healing.

To restore blood flow in the area of the bedsore, special preventive measures are taken, which will be discussed below. To stimulate the rejection of necrotic masses, special medications are used (clostridiopeptidase + chloramphenicol). If necessary, during primary treatment, areas of necrosis are removed using special instruments.

After the wound is completely cleared of necrotic tissue, dressings with alginates (special powder or wipes for filling wounds) are applied, hydrocolloid dressings and dressings with wound-healing preparations are applied. When a bedsore is complicated by a bacterial infection, local antiseptic and antibacterial agents. Elderly patients and patients with severe bedsores are treated with antibiotics. If a large defect has formed after a bedsore, skin grafting may be required.

Prognosis and prevention

The prognosis is determined by the severity of the bedsore and the nature of the underlying pathology. Prevention includes the following measures:

Daily skin checking is a mandatory procedure that should be carried out when caring for all seriously ill and disabled people. It is necessary to pay special attention to areas of bony protrusions and areas at risk of developing pressure sores.
To prevent bedsores, you should change the patient’s position in bed every 2-3 hours, use special devices (inflatable rings, etc.) and anti-bedsore mattresses. All movements of the patient should be carried out with the utmost care to avoid friction or stretching of the skin.
You need to use soft bedding and clothing made from natural materials. It is advisable that the clothes do not have buttons, fasteners or other elements that can create a source of increased pressure on the skin.
It is necessary to maintain a comfortable temperature in the room - not too low to prevent the patient from catching a cold, and not too high to avoid excessive sweating and the formation of diaper rash, which can later turn into bedsores.
Bed linen must be changed promptly, dry and clean. If necessary, use special hygiene products(absorbent diapers, diapers, pads, etc.).

The skin of bedridden patients becomes thin and very vulnerable to damage, so caring for it must be careful and delicate. It is undesirable to use strong-smelling or alcohol-containing products. cosmetical tools, which can cause allergies and skin irritation. It is preferable to use special gentle hygiene products. It is necessary to ensure that the patient’s skin always remains dry and clean: wipe it with a soft towel when increased sweating, remove natural secretions (feces, urine) from the skin as quickly as possible, carry out hygiene of intimate areas after each bowel movement and urination.

Changing bed linen must be done using special techniques, turning the patient over and rolling him onto clean sheets, but in no case pulling the linen out from under him. The patient should also be encouraged to move and ensure that his diet is moderate, balanced, rich minerals and vitamins, but relatively non-caloric, since due to low mobility the number of necessary calories in such cases decreases.

Bedsores are a process of tissue death that appears due to circulatory problems in a particular area of the body. They appear most often in elderly bedridden patients, but in younger people this process can also begin, for example, due to prolonged wearing plaster cast. They develop on those parts of the body that are in contact with a hard surface for the longest time. The most common type is bedsores on the buttocks. Extremely rarely they can be observed on such parts of the body as the back of the head, ribs and fingertips.

Such tissue necrosis is dangerous because, with outwardly insignificant manifestations, bedsores can have a destructive effect on the deeper layers of the skin, joints and even bones, and if not treated in a timely manner, the only way to get rid of them will be to remove the affected part of the joint. The effect of bedsores on bone tissue is called and is accompanied by purulent neoplasms, often in the form of a circle (with an unpleasant odor). The disease does not have any specific symptoms in the early stages, so such patients need to be examined regularly.

Depending on the damage to the skin, treatment of bedsores can be carried out in several ways, the simplest of which is to perform dressings and rubdowns at home. But in particularly advanced situations, surgical intervention cannot be avoided. If you follow simple rules for preventing bedsores, there is a high probability of protecting a bedridden patient from the development of such an illness. To do this, you need to place a special mattress and a soft circle under the patient, and also periodically change its position.

In the international classification of diseases (ICD 10), bedsores have eigenvalue– L89 (also called decubital ulcer).

Etiology

Bedsores are formed due to prolonged contact of bone with the hard surface of a bed or wheelchair, which leads to insufficient blood circulation in the vessels, the supply of little oxygen and nutrients, and ultimately a certain area of tissue dies (usually around the joint).

The risk group includes patients who are partially or completely immobilized by the following factors:

serious fractures lower limbs or spine, due to which a person is forced long time to be motionless;
surgical intervention. Often people are forced to lie down for several months after surgery;
coma state;
paralysis;
or, conversely, a critical decrease in body weight, in which it is not possible to perform active body movements.

In addition, there are reasons that increase the risk of bedsores in bedridden patients:

certain brain injuries due to which the patient does not feel discomfort or pain. For example, with paralysis, bedsores can be found in such an atypical place as the heels or toes, which arise from prolonged pressure from shoes;
age category. The highest percentage of such death of skin tissue is observed in older people, since they are most susceptible to serious injuries, from which it is extremely rare to recover;
skin condition. With increased humidity or dryness, there is a high probability of neoplasms occurring on the epidermis;
Poor nutrition and lack of fluid. In a lying position, certain areas of the skin do not receive proper saturation. nutrients, and in cases of poor nutrition and insufficient water, the patient’s situation only gets worse;
the patient's inability to independently hold urine and feces. Exposure to fluid and bacteria from stool makes the skin more susceptible to pressure sores;
various diseases leading to circulatory disorders, for example;
abuse of nicotine by bedridden patients;
Not proper care for the sick.

Varieties

As mentioned above, bedsores are caused by prolonged rubbing of the skin against bedding or a wheelchair. In the medical field, there is a certain classification of this process according to the degree of spread of the pathological process deep into the tissues. There are the following stages of bedsores:

initial - there is a slight tightening of tissues, swelling and a change in color of the area of the skin that was subjected to pressure. In this case, the problem can be solved at home using quickly healing medications;
moderate severity - erosions and ulcers begin to appear, but the skin is not affected so severely that you need to consult a doctor, since the effect is only on the top layer of a person’s skin. Decrease inflammatory process able medicinal ointments from bedsores, and special soft circles that adjust to the affected areas of the patient’s body will help relieve pressure;
severe - it is characterized by damage to the deeper layers of tissues and joints, the release of purulent fluid that has a pungent and unpleasant odor. Treatment of this stage is quite problematic;
complicated – death of the skin and a strong negative effect on joints and bones. Conservative means do not have the required effect, so they resort to surgical intervention.

Based on the body position of bedridden patients, neoplasms can be localized:

if a person lies on his back all the time, he will develop bedsores on the back of his head, shoulder blades, and may also develop bedsores on his heels;
the position of the patient on his side contributes to the formation of bedsores on the thigh, tip of the ear or along its entire surface, shoulder, knee and ankle;
if a person lies on his stomach for a long time, he will develop bedsores on his knees, elbows, and less often on his fingertips;
those who use a wheelchair always develop bedsores on the buttocks, spine, shoulder blades and those places of the lower and upper limbs, which are constantly in contact with the chair.

Symptoms

Symptoms of bedsores depend on the main component that led a person to a state of complete or partial immobility, as well as on the stage of skin damage. But very often the disease occurs without any symptoms.

Thus, the symptoms of bedsores are:

a slight feeling of pain and numbness that does not cause discomfort to bedridden patients;
change in skin tone from normal to pale pink, with a clear outline. This makes it possible to notice that healthy tissues are not involved in the inflammation process. May occur in the second stage of the disease.

Severe stages of bedsores are characterized by other symptoms:

pus discharge unpleasant odor from ulcers, healthy tissues are affected very quickly;
heat and fever;
intoxication of the body;
change in heart rate;
lowering blood pressure;
rapid breathing;
urinary and fecal incontinence.

Bedsores on the heels have separate symptoms:

tingling feeling;
loss or partial decrease in sensitivity;
the appearance of a white spot.

Special soft circles that are placed under the disturbing sore spot help to reduce the intensity of signs of bedsores.

Complications

The consequences of such a process of tissue death occur only when symptoms are ignored, treatment is not timely, or by the wrong means prevention of bedsores. These consequences may be:

infection of wounds or ulcers by insect larvae;
death.

Diagnostics

Diagnosis of bedsores is easy based on characteristic external signs(bedsores often take the shape of a circle) and symptoms. There are no specific methods for diagnosing bedsores. The only reason for holding laboratory research The discharge of fluid mixed with pus from ulcers is considered. To determine the pathogen that led to this result, fluid is taken or scraped from the wounds. After which the doctor determines how to treat the bedsores.

Treatment

Treatment of bedsores is possible in several ways - from providing assistance at home using various means, before surgery.

The main task of doctors in treatment is to restore blood flow in the affected tissues and prevent further spread of bedsores in depth. For this purpose, antibacterial substances are prescribed to treat wounds. If necessary, the doctor cleans the wound of dead tissue. After this, the affected area is bandaged using wound healing agents.

Prerequisites for inpatient treatment Bedsores are severe stages of tissue inflammation. The main task is to eliminate symptoms and prevent the formation of complications. Surgeries are performed to remove and replace joints, and, if necessary, bones.

At home, only bedsores of the first stages, which occur without symptoms, are treated. To do this, relatives of patients must:

if necessary, place soft circles under the affected areas of the skin to reduce friction on a hard surface;
regularly, every three hours, change the position of the patient’s body;
treat the affected areas of the skin, but under no circumstances use iodine, brilliant green and hydrogen peroxide for this, but first consult with specialists who will prescribe healing agents.

Treatment with folk remedies is not attempted, although there is a lot of controversy surrounding this topic in the medical field.

Prevention

Prevention of bedsores is carried out by people close to the patient, who must adhere to certain rules:

Inspect and treat the skin daily special ointments, powders and other means to prevent bedsores;
provide proper nutrition, enriched with vitamins and minerals;
use a special mattress against bedsores, which will help protect a bedridden patient from skin death;
massage the whole body, paying special attention to the tips of the toes and face;
monitor the temperature of the room where the injured person is located - it should be comfortable for him;
inspect bed linen and clothing for wrinkles;
carry out hygiene measures and change underwear in a timely manner;
for urinary and fecal incontinence;
If you notice the first symptoms or general malaise of the patient, immediately call a doctor at home.

Bedsores are one of the most difficult problems in caring for bedridden patients. They are a consequence of being forced to remain in the same position for a long time. Bedsores often form in patients in intensive care units, in comatose states, with spinal paralysis, during the period of post-infarction and post-stroke rehabilitation.

Bedsores are neurotrophic changes in tissues that have been in prolonged contact with a hard bed or other surface. This phenomenon is expressed in denervation, impaired lymph circulation, poor blood supply to areas of the skin, muscles, and subcutaneous tissue. After just 2 hours of being completely immobile, problems with blood flow begin in the “sitting” and “lying” areas of the body due to compression of small vessels. Bedridden patients are in a stationary state much longer, and some permanently, so their disorders become persistently pathological.

The second reason why destructive processes occur in tissues is vascular microtrauma from friction that occurs when a patient moves by crawling to change position and as a result of forceful pulling from under lying wet underwear.

Factors contributing to the development of bedsores are divided into 2 groups:

Additional factors significantly increase the likelihood:

diabetes;
dehydration;
bread and cheese;
intolerance to care products;
smoking;
sweating during hyperthermia;
spinal lesions and brain injuries.

How to identify bedsores

In young patients who do not have severe chronic diseases and those who are conscious, bedsores are rare and develop slowly. With proper care, their occurrence can be prevented. Weakened patients are susceptible to rapid progression of pathology.

The algorithm for the prevention of bedsores in bedridden patients provides for mandatory inspection of all risk areas, taking into account the forced position (sitting, on the side, on the back, on the stomach):

Upon examination, the incipient pathology is characterized by stagnation of fluid, pronounced cyanotic erythema without certain limits, similar to a bruise, as well as desquamation of the epidermal layer with or without vesicular elements.

Manifestations of venous erythema are:

normal temperature of the affected area, as opposed to inflammatory hyperthermia;
When pressed with a finger, the skin on the hyperemic area turns pale, while the hematoma does not change color.

Subjectively, patients who are in themselves present the following complaints:

Tingling caused by lymphatic congestion and compression of the capillaries supplying the peripheral endings in the area of a potential bedsore.
A feeling of numbness that occurs after a couple of hours of immobility.

Bedsores develop in stages, starting with stagnation of blood circulation and ending with necrotic processes in tissues. In weakened patients with congestive lesions due to cardiovascular pathology, the transition from one stage to another can occur in a matter of hours.

Consequences

The main danger of bedsores is necrotic processes with the addition of infection. For the patient this may end:

leg amputation;
excision of large areas of soft tissue, resulting in denervation and poor blood supply to adjacent areas;
development of periostitis, osteomyelitis with the spread of necrosis to bone tissue and periosteum;
depletion of immunity;
complication of treatment of the underlying disease.

The severity of the consequences of bedsores largely depends on the type of pathological changes in the tissues:

Dry necrosis has a protracted course with a long period of restoration of the wound surface.
Weeping necrosis occurs with infection of the cavity by pathogenic microbes (staphylococci, streptococci and others). Purulent inflammation leads to the formation of phlegmon, erysipelas, and gas gangrene. These processes are characterized by symptoms of intoxication of the body, high temperature, formation of fistulas. The focus of suppuration is local or diffuse, glossy, hyperemic, hotter or colder than the surrounding skin. When a wound is infested with clostridium, the inflammation increases in a putrefactive manner with the development of gas gangrene. With this pathology, the skin acquires a bluish tint, the wound does not look wet and emits strong smell. If you pass over the affected area, a characteristic crunching sound occurs.

A logical continuation purulent bedsore is sepsis: infected exudate from the wound cavity enters the blood. Blood poisoning with the modern level of medicine is a fairly rare occurrence. But it is likely when antibiotic therapy is started late, the patient’s body is resistant to the drugs used, or the patient is in an immunodeficient state.

At the initial stage of development of bedsores specific treatment not required. Measures are being taken to eliminate stagnation: massage without aggressive influence on the affected areas, use of anti-decubitus devices, careful hygiene, use of preventive and therapeutic external agents.

The first stage of bedsore treatment

The appearance of wound cavities, especially infected ones, requires hospitalization of the patient with antibiotic therapy and surgical treatment:

Emptying the wound from purulent contents.
Ensuring the outflow of accumulating exudate.
Relieving swelling and inflammation.
Suppression of microbial activity.

Cleaning of bedsores from purulent cells and dead tissue is carried out in a surgical hospital, then drainage is installed. Further treatment can be done at home. It is important to regularly fill the cavities with napkins or high-quality bandages (dense, not crumbling into threads) with medicinal impregnations, and change them in a timely manner.

How to treat bedsores in bedridden patients:

The use of new generation antiseptics has been approved for washing wounds:

iodopirone solution at a concentration of 0.5%;
dioxidine solution 1%

In their absence, irrigation with hydrogen peroxide, furatsilin, and boric acid solution is allowed.

Enzyme therapy is also used to absorb pus. Pure proteolytic enzymes (chymotrypsin, trypsin, ribonuclease) or as part of an ointment (Iruksol, Iruksovetin) are injected into the wound.

In addition, physiotherapeutic methods are used:

Ultrasound cavitation;
laser irradiation;
exposure to a vibraphone;
pressure chamber, etc.

Second stage of therapy

After cleaning the wound, it is necessary to ensure the growth of healthy tissue. At this stage, a scab should appear - a thin crust granulation tissue. It is important to protect young connective tissues from inflammation, damage and stimulate development. How to treat bedsores in bedridden patients at the beginning of healing:

anti-inflammatory drugs Levomekol, Methyluracil, Troxevasin ointments, Bepanten and other external agents;

for protection, softening and regeneration – oils from sea buckthorn, rose hips, juice fresh leaves aloe, Kalanchoe extract;
for active epithelization of tissues - laser exposure.

Third stage of treatment

The last phase of pressure ulcer therapy consists of complete regeneration and scarring of the wound surface. The main task is to maintain the active process of epithelization, for which they use complex vitamins, immunostimulants, wound healing ointment EDAS 201M. The administration of antibiotics is indicated at all stages of treatment of purulent bedsores.

The patient’s nutrition is of no small importance in the treatment of bedsores. The diet must be saturated with a rich vitamin and microelement composition with an emphasis on sources of iron, zinc, vitamin C:

Skin treatment for bedsores

Treating the skin is an important part of treating and preventing congestion. It consists of three stages:

Hygiene: cleaning skin from dirt, physiological secretions, maintaining normal moisture, softening. There are special care products for bedridden patients: lotions, emulsions, creams.
Prevention: care that prevents the formation of cracks, stimulates local blood circulation, and restores sensitivity. To prevent bedsores, use a solution of ammonia (0.5%), alcohol solution tannin (1%), diluted camphor alcohol (2%), 1% salicylic alcohol. The skin in areas in contact with the surface of the bed and chair must be wiped 2 – 3 times a day.
Treatment: use of drugs in pharmaceutical forms for external use (ointments, powders, solutions, etc.).

magnesium sulfate at 25% concentration;
sodium chloride solution with chymotrypsin;
chlorhexidine diluted with water;
Multiferm napkins that create a therapeutic wound covering from a polymer material and an enzyme complex.

Solutions of potassium permanganate, iodine, and brilliant green should not be applied to bedsores, since they have a drying effect.

Regular proper care for inpatients is the key to successful prevention of bedsores. It is errors in hygiene that are main reason congestion and tissue damage.

The algorithm for the prevention of bedsores in bedridden patients includes the systematic implementation of a number of measures:

The patient's position must be changed every 2 hours;
to support the limbs and create gaps between the body and the bed, the use of special bolsters is recommended;
the head of the bed should be below or at the level of the surface of the bed;
Hygienic procedures and skin moisturizing should be carried out at least 2 times a day;
to care for the patient, it is better to use specially developed pharmaceutical cosmetics;
You can bathe immobilized patients in a warm bath, hot water is prohibited;
remove the consequences of uncontrolled bowel movements and urination as soon as possible;
You can’t use oilcloth or polyethylene as linings; for this there are absorbent “breathable” diapers, pads, diapers, disposable panties;
You regularly need to blot moisture from the surface and in the folds of the skin (sweat, water, other liquids) using absorbent wipes or soft cotton rags;
bed linen must be changed frequently as it gets dirty;
remake the bed at least twice a day, straightening out all folds and unevenness;
carefully place and remove the vessel;
do not pull wet laundry out from under it;
Intense massage is prohibited; it is allowed to “disperse the blood” with light stroking movements without pressure or friction;
for bedridden patients, it is advisable to purchase an anti-decubitus mattress with pumps to correct the density and level of various zones;
Wheelchair users should change position hourly;
to support the body and limbs of those sitting, there are special pillows with air, gel and foam filler;
to protect cracked skin of the lower extremities and sacrum, you can apply a hydrocolloid dressing Comfil Plus;
caregivers should use latex gloves without powder.

To facilitate care and prevent bedsores in bedridden patients, you can purchase specialized products from the Seni and Menalind brands at the pharmacy: diapers, absorbent panties, diapers and napkins, detergents for the body, including water-free washes, protective creams with zinc oxide, moisturizing oils and lotions, shampoo-free hair wash caps, etc.

Let's consider how to treat bedsores (lat. decubitus) depending on the stage of their development and location. Let's figure out what pharmaceutical drugs and verified folk remedies will help cope with the problem in the elderly than smearing wet, dry and purulent wounds. Let's find out who is at risk of the disease and what to do to prevent it.

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Pathology is necrosis (death) of soft tissues, which occurs in bedridden patients when blood vessels and skin are compressed between two solid bases: the surface of the bed and protruding parts of the skeleton. This is one of the most unpleasant complications for people confined to a bed or a wheelchair.

How to properly treat bedsores at 4 stages of formation - 18 expert tips with photos

When deciding how to properly treat bedsores, it is advisable to consult with doctors. By adhering to a certain algorithm of actions, you can stop the destruction of tissue at home. Therapeutic measures depend on the depth and location of the changed tissues.

Doctors distinguish between superficial and deep wounds - they are classified into 4 stages according to the depth of tissue damage (see photo). Each stage has its own characteristics in treatment, which are described below in detail for each stage. A total of 18 expert tips for healing wounds are provided.

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If the patient remains on his back for a long time, ulcers may appear on the back of the head, shoulder blades, elbows, tailbone, sacrum, and heels. If an individual is forced to lie on his side, then wounds “settle” on the thigh, side of the knee, and ankle. Damage is recorded on the pubis and cheekbones when a person lies on his stomach for a long time. See the photo below for the location of the affected areas of the body.

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The first stage is the initial, easiest. It is characterized by the appearance of edematous, hyperemic (reddened) areas on parts of the body in contact with the bed. It is characteristic that when you press them there is no white mark left. Sometimes, instead of redness, pronounced cyanosis (cyanosis) is observed.

Look at the photo to see what tissue damage looks like at stage 1.

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Let's figure out what to do if found initial stage bedsores, how to prevent further necrotic tissue changes, restore skin tone. Note that the detection of a reddened and roughened area in immobilized (completely or partially) patients is a signal of improper or insufficiently careful patient care.

The following actions will help prevent the progression of pathology in bedridden patients:

After 2-2.5 hours, change the patient’s position. To keep the affected areas suspended, it is convenient to use a special backing (inflatable) ring. This will remove pressure from the injured area, provide access to air, and protect it from moisture.
Take air baths at least 2 times a day (avoid hypothermia).
For hygiene procedures use simple soap (antibacterial soap kills both pathogens and beneficial bacteria), natural sponge (cotton washcloth), clean water. After washing, pat the skin gently - do not rub under any circumstances.
Morning and evening, massage the area around the redness with smooth circular movements. It is convenient to do this using a terry towel mitten. Do not rub or knead the surface of hyperemic (reddened) skin.
Carry out quartz treatment once a day - ultraviolet light kills bacteria on any surfaces. The procedure can be carried out using a device home medicine"Sun". It is advisable to agree with the doctor on the number of procedures.
Do not damage the integrity of the reddened (darkened) cover.
In case of urinary (fecal) incontinence, promptly change diapers or diapers made of cotton fabric, and perform toileting of the genitals. For the stronger sex, use a urine collection system.
At profuse sweating wipe the skin with a weak solution of food vinegar - 1 tbsp. Dilute a spoon in 250 ml of cool water.

Fighting pressure wounds at home is a painstaking and ongoing process that requires diligence.

Should be adhered to simple rule: dry wet skin (with sweating, secretion of physiological fluids), dry skin - moisturize. Dryness leads to peeling of the protective (horny) layer of the skin. Excessive phlegm leads to infection of the affected areas. All this is aggravated by poor circulation in compression areas.

How to treat a developing bedsore? Areas of redness can be lubricated:

camphor alcohol
lemon, cut in half
zinc ointment
sea buckthorn oil
tincture of Sophora japonica

Treat any stains that appear once every two hours. It is not recommended to use potassium permanganate, brilliant green, iodine, since they dry out the epithelium and disrupt granulation tissue.

Heels are more dry. They are lubricated with Vaseline, baby cream, and other moisturizers.

At this stage, it is effective to use bandages TenderVet 24(TenderWet 24), TenderVet 24 active (TenderWet 24 active). What ointment should I use for persistent redness? Doctors recommend using drugs that improve blood circulation. In particular, these include:

Solcoseryl (price from 120 rub.)
Actovegin (from 41 rub.)
Bepanten (from RUB 305)

note that the use of softening compounds, blind and wet dressings that block the penetration of oxygen and evaporation of moisture leads to the formation of wet necrosis and tissue destruction.

To make the actions clearer, watch the video, which clearly shows what actions to take at the first stage of bedsore formation.

Treatment of pressure wounds at stage 2

The appearance of ulcers and blisters with hemorrhagic or serous contents is characteristic of the second stage - see the photo below.

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Caring for the affected area includes the following:

Rinsing hyperemic skin with chlorhexidine or hydrogen peroxide.
Applying bandages with any healing ointment - Actovegin, Levosin, Solcoseryl, Levomekol.
Using modern self-adhesive wound dressings: Cosmopore (made of soft non-woven polyester material with an absorbent pad), Tegaderm (a special transparent film that serves as a barrier to moisture and does not interfere with gas exchange).
Covering affected areas with anti-decubitus bandages Hartmann(Hartmann) and ointment dressings: Atrauman Ag (silver-containing), Hydrotul (hydroactive), Branolind N (with Peruvian balsam).
The use of modern dressings PermaFoam cavity, Hydrosorb gel, TenderWet active cavity, which accelerate the process of cleansing and healing of wounds.
Application of applications with substances with wound-healing characteristics. For example, the use of multilayer coatings Multiferm, Proteox-TM, hydrogel dressings Hydrosorb Comfort, etc.

At this stage, it is important to assess the patient’s general condition, which makes it possible to detect or exclude factors that can aggravate the development of the negative process and cause more severe damage.

Specialists can prescribe detoxification of the body - blood transfusion, hemodez (antitoxic plasma replacement agent), immunostimulating therapy - taking vitamin complexes, immunostimulants.

Treatment of deep bedsores at stages 3 and 4

An open wound covered with pus is characteristic of the third stage. The pathological process covers deeper layers, destroying the skin, subcutaneous tissue, and muscle mass, as can be seen in the photo.

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On fourth stage the depth of damage increases - the tendons are injured. The inflammatory-purulent process can spread to adjacent bones (see photo).

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If at deep wounds Only soft tissues are destroyed - skin, muscles - then competent selection will help pharmaceuticals. Healing deeper damage (down to the bones) is solved surgically.

The medications used are conventionally divided into the following groups:

Necrolytic drugs (accelerate the removal of dead tissue)
Anti-inflammatory drugs
Tissue repair (restoration) stimulators
Medicines that improve blood circulation

Various sprays for bedsores are practical and convenient for use in bedridden patients, for example, Chemi spray (price from 480 rub./370 UAH), Olazol (cost 250 rub./76.17 UAH), Menalind (380 rub./ 165.50 UAH). Atrauman Ag silver wipes (RUB 78 / UAH 40.95) reliably protect against the negative effects of pathogenic bacteria.

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3 stages of healing deep bedsores

Deep pressure wounds are treated in stages. They are always infected and contain a significant amount of dead tissue and pus. Their main danger- can cause general blood poisoning and pose a threat to life.

At the first stage The lesion is cleaned of pus and necrosis using enzymes. Are used PAM-T dressings(for strong discharge), Proteox-TM (for moderate and slight discharge).
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The course of treatment is 7-10 days. The cleaned wound becomes bright red. The amount of pus discharged from it is significantly reduced. If surgical treatment of the problem area has been performed before, then proceed immediately to the next stage.

Purpose second stage is to stimulate the appearance of young connective tissue. Speed up this process Wound healing preparations based on enzymes will help. Absorbent dressings Biatain can create ideal conditions for the healing of exuding (wetting) wounds.

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Third stage therapeutic measures are associated with the protection of young connective tissue. Hydrocolloid coatings Comfeel Plus are the most effective means at this stage: reliably protect against infections, create better conditions for tissue regeneration, do not require frequent dressings - 1-2 times every 2-5 days.

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Modern treatment methods, for example, the use of vacuum therapy (NPWT or VAC-therapy), contribute to accelerating wound healing in the elderly.

Surgical intervention for deep injuries consists of repeated excision of non-viable tissue (necrectomy); in case of severe damage, autodermoplasty (plasty with a displaced musculocutaneous or skin flap) is performed. Before surgery, innovative techniques can be used - magnetic electrical stimulation, laser electrical stimulation.

Folk remedies

Tandem of drug treatment and traditional medicine will help you get rid of the pathology faster. Let's look at the most common recipes and recommendations for treating tumors from prolonged lying down.

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To simplify the treatment of bedsores on the tailbone and buttocks (often occurring simultaneously) at home, bandages with an antiseptic will help.

Before applying them, you should treat the surface with a mixture of water and vodka (1:1), a solution of vinegar (1 spoon per cup of water), and camphor alcohol. Next apply Panthenol Spray, Methyluracil.

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How to quickly lubricate redness and sores on the buttocks and tailbone? An excellent effect is achieved by using a mixture of essential oils: myrrh, geranium, tea tree, petitgrain, St. John's wort macerate. Oils have an antiseptic and healing effect. Take 2-3 drops of each oil. Do an oil compress once a day.

Another thing that will help you get rid of sores on your buttocks from sitting: good remedy – sea buckthorn oil. On the forums you can find many excellent reviews about the miracle oil. The substance improves blood circulation and has an antimicrobial effect. In addition, it helps with gastritis, stomatitis, and hemorrhoids.

Before use, disinfect the affected areas on the buttocks of a bedridden person with camphor alcohol. Sea buckthorn oil can be alternated with rosehip oil, which has a similar effect.

The use of an anti-decubitus circle will simplify care both for severe injuries and for the first symptoms of pathology.

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A few important nuances:

The circle must be set so that the wound is in its center.
The product should be covered with film to prevent skin friction.
The circle should not be overly rigid - just slightly raised above the bed.

Often on forums there are questions about how to remove ulcers on the butt and tailbone using gentle folk remedies, how to treat wounds in an immobilized patient with a tendency to allergies?

Doesn't call allergic reactions a mixture of vodka (high-quality) and any shampoo for children (or natural botanic). Pressure wounds are lubricated with the composition once a day. After 10 hours, rinse with clean water. This method has been personally tested. At stage 1 of the lesion it gives good result and removes odor.

How to get rid of wounds on the heel and leg. Photo

Initially, on the upper layer of the epidermis of the heel, White spot, then a red bubble forms, which quickly turns into a black spot. Green “healers” will help speed up and facilitate the healing of wounds on the heels.

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We suggest using many times tested recipes:

Dip fresh elderberry leaves in boiling milk and apply to ulcers.
Apply freshly prepared juice from lungwort leaves to the reddened areas 4-5 times a day.
Prepare: 1 tbsp. l. Grind the flowers (it’s convenient to use a coffee grinder) and combine with 50 g of Vaseline. Apply twice daily.

Will promote healing of the epidermis cabbage leaf, slightly kneaded in the hands and bandaged to the heel. You can secure it with a bandage until the morning Kalanchoe leaves- cut in half (lengthwise) and apply the cut to the bedsore.

How to say goodbye to back ulcers

Beginning changes on the skin will be removed by a simple mixture of camphor, medical alcohol and baby shampoo(100 ml of each component). It will give you a feeling of freshness and cleanliness. Treat the problem area in the evening. In the morning, wipe with a sponge soaked in warm water. Using a soft towel, dry the skin thoroughly (without rubbing!). Continue procedures until complete recovery.

Recipe 1 Bring half a cup of vegetable oil to a boil. Add a piece beeswax, the size of half a little finger. Stir the mixture thoroughly and cool. Use the resulting ointment to treat redness and ulcers.

Recipe 2. Use cotton fabric as a filler for a mattress. raw oats last harvest.

Recipe 3. Steam a handful of millet, pour into a cotton bag. Place under the affected area. After 4 hours, remove the bag. For a large affected area, use several bags.

Recipe 5. Prepare a linen towel (preferably an old one) and a cut glass. Pour 1 tsp into a glass. soda, pour boiling water and moisten the fabric with the resulting solution. Allow the fabric to cool slightly, squeeze lightly, and place on the affected area.

Lotions from fish oil, clove oils at night will help fight bedsores in the elderly. Regular potato starch can be used as a powder for weeping wounds.

We learn another way to improve the condition from the video “How to treat and treat bedsores.”

Which doctor will help, where to undergo the procedures

When pathological foci are detected in bedridden people who are at home should contact family doctor or a therapist. With progressive manifestations of the disease, it is necessary to consult a surgeon. A dermatologist or infectious disease specialist will help you choose medications and tell you how to quickly deal with the problem.

Depending on the course of the pathology and the condition of the individual drug therapy carried out at home or in a hospital.

Who's at risk

Bedsores form quite quickly in older people. Characteristic for most elderly patients:

at and femur — 66%
with paralysis of the lower and upper limbs (tetraplegia) – 60%
during stay in intensive care units – 33%
in bedridden patients (especially the elderly) who are at home – 25%

Circulatory disorders are observed when diabetes mellitus, acute vascular occlusion, obliterating endarteritis. Smoking slows down recovery because nicotine constricts blood vessels, which leads to poor blood supply.

Prevention

In order to prevent the occurrence of pathology in patients who remain in a sitting or lying position for a long time, bedsores should be prevented in a timely manner. Experts recommend using special cellular (dynamic) mattresses.
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They are effective because:

They guarantee uniform distribution of the patient’s weight over the surface and adapt to the contours of the body.
Ensure free blood circulation throughout the entire area of the skin. The honeycomb constantly moves, promoting normal blood flow.
They help neutralize emerging areas of rejection (in 9 out of 10 cases).

A massage (occipital) pillow will help prevent pathology - it “remembers” the contours of the neck and shoulders. The rectal pillow will ensure that the individual is comfortable in a sitting or lying position.

Advice : When purchasing a mattress, take into account the weight of the patient so that a “sagging effect” does not occur. This may lead to the disappearance of the therapeutic and prophylactic effect of the accessory.

You learned how to treat bedsores depending on the stage of the disease, location, what pharmaceuticals and folk remedies will help cope with the problem, what to apply to weeping, dry and purulent wounds in the elderly, as well as who is at risk of the disease and what to do for prevention. The information received was supported by photos and videos.

Health to your loved ones!

A bedsore is open wound on the surface of the skin. In especially advanced cases it reaches deep muscle layers, and is characterized by abundant necrotic tissue lesions, often with connection bacterial infections. Bedsores are formed due to mechanical compression of the local network of small blood vessels when the patient remains in one position for a long time. Such disorders, as a rule, occur in bedridden or sedentary patients who cannot or for some reason do not want to regularly change the position of their body.

Stages of bedsores and reasons contributing to their appearance

Impaired mobility is one of the most common causes of the development of bedsores as a result of the compressive effect on the blood vessels of the subcutaneous tissue. Most often, bedsores are observed in visually impaired patients under anesthesia, suffering from severe psychopathological conditions, with a history of severe pathologies of the musculoskeletal system or central nervous system, or recovering from a major operation or injury. Patients, for a number of reasons, cannot change the position of their body often enough, and the influence of their own body weight puts serious pressure especially on those areas of the skin that protrude above the general surface.

The second most important cause of the development of bedsores is the rupture of small blood vessels that supply a certain area of tissue due to dragging the patient across the bed, pulling out wet underwear or sheets from under him, or pushing up the bedpan.

There are several complicating factors that, among other things, contribute to the development of pressure ulcers.

Limitation of joint mobility (contractures) and increased tone skeletal muscles(spasticity)

Prevents normal movement of the patient's body. Joint contractures most often occur with tendon injuries, arthritis, scar formations on the surface of the skin, or disorders of central nervous regulation. Severe damage to the cerebral or spinal apparatus often leads to a spastic state muscle mass in the area of the extremities and abdominal cavity.

One of the most important stimuli for changing body position is pain.

Various neurological disorders or long-term use of painkillers can significantly reduce pain threshold, thereby not informing consciousness about the need to reposition the body.

Increased pain sensitivity due to surgical or traumatic wounds

This may force the patient maintain a static position at all times.

Plays a significant role in resisting pathological processes resulting from compression of blood vessels and nerve endings. physiological state skin

Strong, elastic skin is sufficiently resistant to the development of bedsores. On the contrary, a thinned, atrophied epithelium, due to a reduced ability to regenerate, is quickly destroyed with an increasing deficiency of nutrients supplied by the blood. Such phenomena often occur when taking certain medications that affect water-salt metabolism in the body and hormonal drugs.

Decreased regenerative functions of the skin epithelium

Thinning of the skin-epidermal junction and organic destruction of the capillaries of the subcutaneous tissue are typical for patients old age. That's why The development of bedsores in older people always occurs faster and is fraught with complications.

The skin becomes more susceptible to even minor traumatic forces as a result of de-epithelialization, which usually occurs due to friction and shear forces when the patient is pulled

Worn areas on the skin have a reduced barrier of protection against bacterial contamination, and are also characterized low content transepidermal water, which leads to maceration of the skin with subsequent stratification.

Constant exposure to high humidity on the skin

May occur as a result of insufficient patient care also lead to damage to the outer skin. The situation is aggravated by the aggressive effects of substances contained in the patient’s feces and urine.

Dirty laundry

This is one of the main reasons for the development of pathogenic microflora in the resulting ulcerative lesions on the skin. The temperature and humidity of the ulcer creates the most favorable conditions for the development of pathogenic microorganisms that are sufficiently resistant to local antibiotic therapy. The neglect of such processes often leads to a transition from a localized purulent-infectious process to a generalized form. In weakened patients Bacteremia, sepsis, myonecrosis or... often develop.

Malnutrition, insufficient protein intake, and anemia

They reflect the patient’s general condition of resistance against infectious and non-infectious types of skin lesions. Poor nutrition inhibits opportunities immune system the body against the effects of pathogenic factors. In addition, anemia results in poor oxygen carrying capacity of red blood cells. The situation is getting even worse with the development cardiovascular pathologies and hypovolemia.

Reperfusion

Restoring normal blood flow in the ischemic area, according to many experts, also contributes to the prolongation of necrotic processes. Accumulated during the period venous stagnation Metabolic products spread throughout the affected area, thereby increasing toxicity in that area.

In patients with normal sensitivity, mobility and the absence of psychopathological abnormalities, bedsores are extremely rare. Feedback from subcutaneous receptors, signaling to the brain about the onset of ischemic processes in the area of compressive effects on blood vessels, forces a person to change body position at a conscious or unconscious level.

The development of bedsores occurs in stages, and the further the stage, the more difficult it is to provide therapeutic effect for ulcerative-necrotic formations.

First stage characterized by the integrity of the skin in the area of compression and the presence of persistent hyperemia for a long time after the pressure is removed.
Second stage - hyperemia of the subcutaneous tissue against the background of the early stages of physical damage to the epithelial surface layers. Observe keratinization and detachment of the skin epithelium at the site of compression.
Third stage - the formation of a deep, weeping ulcer with complete destruction of all layers of the skin and the transition of pathological processes of necrosis to the subcutaneous tissue and muscle tissue.
Fourth stage characterized by a very deep spread of pathological processes, right down to the bones and muscle fascia.

Pathophysiological basis of pressure ulcer formation

For the first time, the pathological processes of the formation of bedsores were described in 1873 by D. Paget, who quite accurately determined the development of necrotic processes as a result of compression of the local subnetwork of small blood vessels. The development of bedsores is influenced by many factors, but the process is always based on ischemic phenomena leading to destruction cell membrane, and subsequently to cell death as a result of insufficient tissue trophism.

From this point of view, bedsores develop from prolonged, constant pressure on the same area, which impairs the blood circulation of the same area of tissue.

For the development of ischemia it is necessary compression effect for arterial capillaries no less than 32 mm Hg and from 12 mm for venous capillaries.
Squeezing of arterioles contributes to a lack of influx of fresh blood saturated with oxygen and nutrients, and compression of venules significantly impedes blood outflow, rich in tissue metabolism products.
Accordingly, in addition to ischemic manifestations, they also observe stagnant processes in compressed tissues, which significantly complicates the pathological process.

Typically, the tissues of a living organism are normally able to withstand much greater pressure than the indicators indicated above. This is facilitated by sufficient elasticity and strength of the cell walls. However, compression effects on the area for more than 2 hours overlap the tissue capabilities with trophic deficiency.

The development of bedsores most often occurs in areas of the skin that come into most close contact with surfaces. Pressure indicators on specific anatomical areas of the patient, depending on body position, are documented. So, when lying down, the most at risk development of bedsores are:

sacrum;
heels;
back of the head

They are exposed to a pressure of about 40-60 mmHg. The chest and knees account for about 50 mm if the patient is lying on his stomach. In a sitting position, the ischial tuberosities are most subject to compression - about 100 mm Hg. It should be noted that a person’s constitution does not play a role significant role in the development of bedsores - than bigger man, the more developed its cellular stroma is. The exception is overweight patients, but in them the pressure on the blood vessels is compensated using the additional shock-absorbing qualities of the fat layer.

Upon reaching the third stage, the pathological process accelerates, it is characterized by more severe damage muscle tissue, which is more demanding in providing oxygen and removing metabolic products. For this reason, the “point of no return” period is set at 2 hours, after which irreversible changes in muscle tissue begin. As for individual skins, they can withstand compression for up to 12 hours.

It is worth noting that, in addition to the immediate lack of blood supply, the processes of regulation of tissue activity in the compressed area are disrupted due to compression of the nerve endings.

Features of the localization of bedsores, symptoms and diagnosis

Pressure ulcers are usually described in terms of the location of the pathological area and the depth of involvement of the underlying tissue.

About 70% of all places where bedsores most often form are in areas of the ischial tuberosities, greater trochanters of the femur.
On heels, ridges ilium, shoulder blades and elbow joints accounts for about 15-25%.
The remaining percentage is distributed to any parts of the patient’s body that come into contact with any surfaces for a long time, for example, when plaster casts are applied incorrectly.

It is worth noting that the formation of pressure sores in the oral cavity is common in the field of dentistry. The areas most often occur at pressure points of dentures, as well as in the interdental crevice space on the gum, which is facilitated by the packing of dense formations from food masses.

Usually, diagnosing a bedsore is not particularly difficult - visually and organoleptically it is possible to determine with a sufficient degree of confidence the development of ischemic processes in the area subject to compression. However, in cases where there is no improvement with correct treatment of pressure ulcers, additional diagnostics may be required to identify third-party pathologies, including oncological ones. Besides, osteomyelitis must be excluded , especially in cases of deep pressure ulcers.

Complete blood count with differentiation may show an increased content of white blood cells, which allows us to judge the possible generalization of the pathological process beyond the pressure ulcer, as well as the development of an invasive infection. The erythrocyte sedimentation rate is higher than 120 mm/h and the leukocyte count is more than 15,000 cells/µl, forcing a series additional research for osteomyelitis.

Food quality, as an integral factor in favorable pressure ulcer therapy, is determined by the presence of albumin, prealbumin, transferrin and the amount of total protein in the blood serum.

A biopsy of wound tissue is performed if there is no improvement despite proper care of pressure ulcers. This examination is carried out to determine the species of bacterial flora that populate the wound surface, as well as to exclude malignant cell growth. Whenever there is an exacerbation of a pressure ulcer that has been in remission for several months or years, a biopsy must be performed. This effect is most often observed with the development of malignant processes in old wounds.

Briefly about the treatment and prevention of bedsores

It is worth noting that there is no panacea for treating bedsores. A series of consistent measures is required to facilitate rapid disposal of the developing pathological area.

The need for maximum restoration of blood circulation and innervation at the site of compression.
Removal formed necrotic masses in the pathological focus.
Promoting speedy healing formed wounds.

You should always remember that the appearance of a bedsore is an indicator of the patient’s neglect in terms of proper care and the correctness of the therapy used. Therefore, if the patient is unable to independently change the position of the body, it is necessary to assign service personnel to him, preferably in the person of the same person, who will always be aware individual characteristics development of possible pathological processes. Unfortunately, in the conditions of a modern Russian hospital, functioning with state support, this is an almost impossible task.

Absolutely all patients whose movement is limited by a wheelchair, bedridden patients suffering from paresis or paralysis of certain parts of the body, as well as diseases that reduce the level of brain activity. Special attention required for people with the following pathologies:

urinary and fecal incontinence;
are at the stage of exhaustion;
obese;
people with diabetes;
with a history of stroke complications.

What are the basic principles for preventing the development of bedsores?

Reduced compression, friction or lateral shear effects of the body.