Bedsores begin, what to do. Risk factors for developing pressure ulcers

Bedsores– these are areas of tissue necrosis due to impaired blood circulation in them. As a rule, bedsores form when a part of the body comes into contact with a hard surface for a long time. Sooner or later, most people with limited mobility develop bedsores, but patients who are overweight, diabetic, or severely malnourished are most susceptible to them.

According to statistics, bedsores develop in 80 percent of patients who are in a supine position. Most often, pressure sores form on the heels and buttocks. The prevalence of this type of tissue damage varies from country to country. In studies conducted in South Korea, for example, pressure ulcers were diagnosed in 47.4 percent of patients in home care and 21.7 percent of patients in intensive care units. In Canada, the prevalence of pressure ulcers is 26 percent. According to British scientists, bedsores occur in 15–20 percent of patients in health care institutions. In the United States, approximately 17 percent of all hospitalized patients are at risk of developing tissue death or already have pressure ulcers. According to the testimony of American scientists, 60 thousand people die every year in their country from complications that develop against the background of pressure ulcers. In the European Union, the prevalence of bedsores in particularly severe forms reaches 150 thousand cases per year.

The search for drugs for local treatment of wounds that would combine high efficiency against wound microflora with the ability to prevent the colonization of wounds by hospital microflora and, at the same time, stimulate wound healing remains an urgent task in surgery. Pectinar surgical napkins can be recommended as an effective drug in the treatment of bedsores.
It works simultaneously in five directions:

1. BACTERICIDAL ACTION
Pronounced selective bactericidal effect on pyogenic microflora (Pseudomonas aeruginosa, Staphylococcus aureus, streptococci, Klebsiella, Proteus, etc.), while beneficial microflora is not sensitive to it. The bactericidal activity of PECTINAR is comparable to that of antibiotics.

2. ANTI-INFLAMMATORY ACTION
In all cases of using PECTINAR, the local use of antibiotics and other antibacterial agents is eliminated, which significantly saves money on expensive drugs and eliminates the occurrence of side effects.

3. PROTECTIVE ACTION
When applied, it forms a protective film on the surface of the wound, relief covering the affected tissue of any configuration, thereby preventing the penetration of pathogenic microflora into the wound, including protecting the wound from colonization of hospital microflora.

4. REGENERATING ACTION
Retains environmental moisture in the wound, which promotes recovery processes and accelerates healing.

5. SORBENT ACTION
Sorbs bactericidal toxins and tissue breakdown products, which promotes the activation of immune processes.

Compound:
stabilized 3% pectin solution (natural polymer of D-galacturonic acid), sterile medical gauze wipes 14x16 cm, two-layer. Sold in pharmacies. The problems of tissue necrosis have been known to mankind for a long time. The first literary mentions of bedsores go back thousands of years and belong to Hippocrates. The French surgeon Ambroise Paré identified the elimination of pressure as the main condition for successful treatment of bedsores. Another French scientist Brown-Séquard in 1852 published his opinion that, in addition to compression, the occurrence of pressure wounds is influenced by high humidity skin. In the mid-20th century, disorders of the autonomic nervous system also began to be considered as causes of tissue necrosis. Before the onset of the 21st century, bedsores were treated mainly surgical method. The ulcers were closed with transplanted skin flaps, excised, and in some cases, bone tissue was removed under the bedsore. Since the end of the 20th century, in the fight against pressure ulcers, world medicine began to pay great attention to the prevention of pressure ulcers. Thus, between 1990 and 2008, the number of publications on topics such as practical guidelines for caring for bedridden patients, the development of risk assessment scales and prevention programs increased by 960 percent.

The average cost of treating pressure ulcers in hospitals in the United States is approximately $11 billion per year. The annual costs of the UK's National Health Service range from £1.4 billion to £2.1 billion, representing around 4 percent of the organisation's total costs. The cost of monthly out-of-hospital treatment for a patient with bedsores in Canada is 9 thousand US dollars.

Treatment and prevention of pressure ulcers has changed over time. So, in ancient times, to alleviate the condition of the patient, a copper basin filled with water was placed under his bed. Another remedy with a more understandable mechanism of action was a bull bladder, which was filled halfway with air and placed under the body of a sick person. This device was a prototype of a modern device for preventing the development or complications of bedsores. One of the effective developments of today is the Mepilex Border bandage, developed by specialists from Molnlycke Health Care. Currently, about 15 studies have been published confirming the high results of using this product.

An interesting study was conducted by American scientists from Medical Nutrition USA. The result of their work was the proven fact that the diet and quality of nutrition greatly influence the speed of healing and restoration of affected tissues during bedsores.

A team of engineers from the University of California has developed a “smart” bandage that provides the ability to prevent bedsores. The device appears to be in the form of a belt containing electrodes. The device unit delivers weak electrical impulses and if the cellular tissues are viable, they do not conduct current. If a cell begins to die, its conductivity of electricity is maximum. By analyzing this characteristic of cells, the device identifies affected areas that have not yet turned into bedsores, which makes it possible to take appropriate measures in a timely manner. The bandage was tested on rodents, and at the moment the developers are going to recruit volunteers to continue the study.

Skin structure, blood supply and innervation

The main layers of the skin are:

• epidermal layer;
• basement membrane;
• dermal layer;
• hypodermal layer.

Main characteristics of skin layers

Epidermal layer ( epidermis)

Sublayers of the epidermis

The epidermal layer is devoid of any blood vessels and lymphatic vessels. Nutrients and water enter through the basement membrane from the dermal layer.

Change of skin epidermis
The skin is the only organ ( except for the liver), which has the property of regeneration. It is constantly updated and is restored quite quickly in case of various damages.

The process of changing the epidermis occurs smoothly in several stages:

• formation of new cells;
• cell migration from layer to layer;
• reduction of the nucleus and flattening of the cell;
• loss of all organelles ( intracellular components) and water;
• filling the cell with keratin and keratinization;
• loss of intercellular contacts and exfoliation of dead cells.

Dermal layer ( dermis)

Characteristics of the sublayers of the dermis

Reticular sublayer of the dermis
The reticular layer is the thickest sublayer of the dermis. Thick collagen and elastin fibers intertwine to create the underlying, strong framework of the skin. Collagen fibers give the skin strength, and elastin fibers provide its elasticity and firmness.
The entire space between the network of intertwined collagen and elastin fibers is occupied by hyaluronic acid. It forms many cells in which it holds water. Once saturated with moisture, hyaluronic acid turns into a gel. This gel keeps the skin elastic, creating a soft frame.

Fibroblasts are located in the intercellular substance near the fibers ( connective tissue cells), which continuously synthesize and destroy collagen, elastin and hyaluronic acid in a vicious circle.

Hypodermal layer ( hypodermis)

The main cellular element of the hypodermal layer is the adipocyte ( fat cell). Therefore, this layer is also called the subcutaneous fat layer. Adipocytes fill all the space in the cells of the “collagen-elastin” network. Their number is constant. An increase in the thickness of adipose tissue occurs due to the accumulation of fat in cells and an increase in their size.
In the hypodermal layer between the adipocytes there are some important elements of the skin involved in its nutrition and protection.

The main elements of skin in the hypodermis are:

• nerve fibers;
• veins;
• arteries;
• network of lymphatic vessels;
• hair follicles;
• sweat glands.

Blood supply to the skin

Arteries, veins and lymphatic vessels form several main plexuses in the dermis and hypodermis, which give rise to many small branches.

Vascular networks of the skin

Arteries

Vienna

Lymphatic vessels

The main feature of all skin vessels is their ability to quickly narrow and expand. This occurs reflexively when nerve receptors in the skin are irritated.

The main external stimuli can be:

• low and high temperatures;
• chemical substances;
• mechanical stimuli ( friction, prolonged pressure, impacts).

Innervation of the skin

The main nerve receptors of the skin are:

• thermoreceptors ( temperature responsive);
• mechanoreceptors ( pressure and stretch receptors);
• pain receptors.

Causes of bedsores

Mechanism of bedsore formation

Circulatory disorders develop due to compression of skin vessels, which leads to a decrease in blood supply to this area. Without blood supply, tissue nutrition does not occur. The lack of appropriate nutrients in the cell leads to its death ( necrosis). Disorders of nervous trophism are added to this mechanism. It is known that the nervous system has a regulatory effect on metabolism in organs and tissues. However, in people with limited movements or with their complete absence, there are disturbances in the conduction pathways of the brain or spinal cord ( those violations that led to immobilization). Thus, the disorders nervous regulation, and disturbances in blood supply are the foundation for the development of bedsores. There are many reasons that lead to the development of these two mechanisms.

For example, this is pressure on the corresponding area of ​​the skin, as a result of which the vessels supplying this area are compressed. It is believed that if the two-hour pressure outside exceeds the pressure in the vessels, then the process of formation of bedsores is maximally accelerated. Another reason is excess moisture of the skin, as a result of which it becomes saturated with liquid and swells. This process is called maceration in medicine. As a result, skin damage in the initial stages of pressure ulcer formation is further accelerated.

Most often, several causes are involved in the development of bedsores.

The causes of bedsores are:

• constant friction or pressure;
• multiple concomitant diseases;
• poor patient care, including unbalanced nutrition;
• overweight or underweight.

Constant friction or pressure

Friction also occurs in cases when exhausted bedridden patients slide out of bed without support in their legs. In this case, a displacement of the superficial layers of the skin occurs in relation to the deep layers. As a result, the smallest vessels of the skin ( capillaries) are torn, and the blood supply to the corresponding areas is disrupted. A similar thing happens when a sheet or blanket is pulled from under a patient.

Multiple comorbidities

Concomitant diseases and bad habits that accelerate development of bedsores, are:

• diabetes;
• pathologies of connective tissue and blood vessels;

The most rapidly progressing bedsores develop with atherosclerosis and diabetes mellitus. With atherosclerosis, large vessels are affected, as a result of which the blood supply is disrupted not only at the level of microcirculation, but also macrocirculation. Thus, an atherosclerotic plaque closes the lumen of large vessels, as a result of which a lack of blood supply is observed not in a limited area, but in entire limbs. In diabetes mellitus, in addition to damage to microcirculatory vessels, a general decrease in immunity is observed. As a result, tissue resistance is reduced and the ability to recover is lost. This explains the rapid progression of bedsores in diabetes mellitus and their resistance to all preventive measures.

When smoking, microcirculation is disrupted not only in the vessels of the hands, but throughout the body. This is due to the fact that smokers’ blood is susceptible to increased thrombus formation ( blood clots that block a vessel). This leads to the fact that the smallest blood vessels in the skin quickly become clogged and fail. Compressing such vessels stops blood access to the tissues as much as possible.

Poor patient care, including unbalanced nutrition

Kinesitherapy is very important for paralyzed patients. Regular sessions with a kinesiotherapist improve blood flow in paralyzed limbs. If it is not possible to conduct classes, it is necessary to use “air bathing” or light massage. Since treating bedsores is a very long and difficult process, it is much more important to prevent their development. To do this, it is important to turn the patient over daily and monitor his skin. If you don’t do this, you may miss the first signs of bedsores ( swelling and redness).

To reduce pressure, special mattresses, circles, and bolsters are used. All these items increase the area of ​​contact between the body and the surface, thereby reducing pressure on areas of the body. In their absence, the risk of developing bedsores increases, since the pressure on the body is maximum.

Patient care also includes a balanced diet. Nutrition should help restore energy costs. If the protein content in the patient’s food is less than 15 percent, and the patient drinks less than one and a half liters of liquid per day, then the recovery processes in the body are much slower.

Overweight or underweight

What do bedsores look like?

Stage 1
The area where erosion subsequently forms turns red and swells. There are no visible wounds, only microscopic cracks invisible to the naked eye. Sometimes the skin takes on a bluish or purple tint. Visually, she looks slightly irritated. Patients may notice local soreness.

Stage 2
A superficial wound forms at the site of redness. It looks like a small depression with pink and swollen edges. This wound affects the epidermis and part of the dermis. Sometimes a bedsore can take the form of a burst bubble of fluid, but more often it has the appearance of an ulcer.

Stage 3
At this stage, a deep wound surface is formed. The defect affects all layers of the skin, reaching the subcutaneous fatty tissue. The ulcer takes on the appearance of a deep crater, at the bottom of which there is yellow necrotic tissue. This tissue consists of dead cells of the epidermis and dermis.

Stage 4
The defect extends to deep-lying tissues. At the bottom of the wound, muscles, tendons, joints and even bones are visible.

Also, bedsores can form deep in the soft tissues, but communicate with external environment through a fistula. This is the so-called fistulous form of bedsore. There is only a small hole on the surface of the skin. It communicates with another wound cavity ( actually with a bedsore) through a narrow convoluted channel ( fistula). The bedsore itself appears to be closed. However, it can be located quite deep. From this deep cavity, purulent contents are separated through the fistula onto the surface of the skin. With this form of pressure ulcers, a common complication is osteomyelitis or purulent arthritis.

In bedridden patients, bedsores usually form on the back ( in the area of ​​the shoulder blades), in the area of ​​the sacrum, heels. If the patient lies on his side, then on the femoral surface, on the shoulder, on the knee. In patients who use a wheelchair, bedsores appear on the gluteal region, on the sacrum, and also on the back of the arms.

Which doctor should I contact for treatment?

The principles of rehabilitation are:

• breathing exercises;
• disembarking the patient;
• passive movements with limbs;
• treatment by position.

However, if deep defects form, then in this case they turn to surgeons. If necessary, he excises the edges of the wound, removing dead and non-viable tissue. It drains ( creates an outflow of pathological fluid from the wound) wound surface, introduces antibacterial drugs there, and also gives advice on further care.

When is inpatient treatment necessary?

Complications of bedsores are:

• bone infections ( osteomyelitis);
• infection of subcutaneous fat tissue.

The first signs of sepsis are high fever and chills. At the first such symptoms, you should consult a doctor. The spread of infection to bone tissue is also a serious complication. In this case, the purulent-necrotic process affects both the bone and joints.
Acute infection of the subcutaneous fat tissue requires immediate surgical intervention, as it can provoke sepsis or meningitis.

Ointments and solutions for the treatment of bedsores

Ointments for bedsores

The main therapeutic effects of ointments for the treatment of bedsores are:

• restoration of normal blood circulation to improve skin trophism;
• stimulation and activation of general and local tissue regeneration processes;
• prevention and elimination of the development of bacterial infection in the wound;
• elimination of possible pain syndrome and uncomfortable subjective feelings at the patient.

Effective ointments that are used for the first stage of bedsores

• argosulfan;
• dermazin;
• zinc ointment;
• cindol.

If pathogenic bacteria enter the wound and signs of infection appear, ointments containing antibiotics are prescribed. Antibiotics are also indicated in cases of deep necrosis with copious discharge.

Ointments that are used to fight infection

• levomekol;
• argosulfan;
• iruksol;
• levosin.

Ointments that are used for the second stage of bedsores

• iruksol;
• betadine;
• methyluracil;
• Thiotriazoline.

Ointments that are used in the third stage of bedsores

• solcoseryl;
• algofin;
• levosin;
• bepanthen;
• thiotriazoline;
• iruksol.

Solutions for bedsores

Daily care of a patient with bedsores

Factors that need to be provided to a patient with bedsores are:

• reducing pressure on the body;
• organization of proper nutrition;
• ensuring proper skin care.

Reducing pressure on the patient's body

Devices that may be used when caring for a patient with pressure ulcers include:

• mattress pads;
• gel pillows;
• linings made of soft materials;
• mattresses against bedsores.

Nutrition and drinking of patients with bedsores

• broths from fish, lean meat, vegetables;
• porridge;
• cottage cheese casseroles;
• steamed omelettes;
• steam cutlets and meatballs;
• vegetable purees;
• milk and vegetable soups.

Principles of proper skin care for bedsores

The goals of skin care for a patient with pressure ulcers are:

• reduction of irritation;
• maintaining cleanliness;
• prevention of secondary infections and aggravation of pressure ulcers.

Limiting skin irritants

Rules for carrying out hygienic measures when caring for patients with bedsores

Skin hygiene products are:

• emulsions that allow you to cleanse your skin without water or soap ( No Rinse washing gel, Seni cleansing foam);
• means for preventing diaper rash ( powders, talc);
• moisturizers ( Healing Derm balm, Menalind lotion);
• healing creams ( Convin Kritik Barrier cream, Badyaga gel, Ambulance balm for wounds);
• preparations for the care of the skin of the perineum when using diapers ( Sudocrem, Bepanten, skin protector Menalind);
• foaming sponges and mittens for water procedures ( Cleanet, Gantnet plus, Ninonet).

Prevention of infections

How to make dressings?

The dressing for the treatment of bedsores must meet the following parameters:

• be sealed to prevent infection;
• be dense ( 8 – 10 gauze layers);
• be breathable;
• the area of ​​the dressing should exceed the area of ​​the wound;
• The edges of the bandage are attached at the level of healthy skin.

The bandage should not be too tight and block the flow of oxygen to damaged tissues. To bandage a patient with bedsores, it is necessary to prepare some tools and materials, as well as have appropriate ointments and antiseptic solutions.

The necessary materials for dressing are:

• sterile wipes;
• tweezers;
• scissors;
• gloves;
• dressing material ( gauze, bandage, special plates);
• patch;
• ointment and antiseptic solution.

Dressing includes four main points:

• opening of a wound;
• treatment with an antiseptic solution;
• applying ointment;
• gluing the bandage.

Currently, there are many special dressing materials for effective treatment bedsores. These materials are impregnated with various medications that promote rapid wound healing.

Special dressing materials

How to treat bedsores with antiseptics?

The main rules for treating bedsores with antiseptic solutions are as follows:

• Do not touch the wound surface with your hands, but only with sterile napkins;
• do not overuse antiseptic solutions;
• exclude the use of iodine, brilliant green, hydrogen peroxide and potassium permanganate.
• the solution is applied to sterile wipes or to the wound directly from the bottle.

How to treat a wound with healing drugs?

Healing drugs for the treatment of bedsores include:

• ointments with silver ions ( );
• complex ointments containing active enzymes ( levosin, levomekol);
• methyluracil ointment;
• solcoseryl ointment;
• algofin ointment
• dexpanthenol ( bepanten);
• special materials impregnated with active enzymes ( multitruss and comfil coatings).

Method of using healing drugs

Physiotherapy for bedsores

At the initial stage of development of bedsores, physiotherapy is prescribed to improve blood circulation and eliminate primary symptoms.

How to choose a mattress for the prevention of bedsores?

Parameters to consider when purchasing a mattress are:

• functionality ( dynamic or static);
• type of material;
• product type ( cellular or tubular);
• presence of microventilation;
• compressor characteristics;
• load capacity and dimensions of the anti-decubitus system.

Static or dynamic mattress

Types of materials from which anti-decubitus mattresses are made

Tubular and cellular mattresses

A cellular mattress is a canvas made of diamond-shaped or square sections, which are filled with air in a certain order and deflated with a break of 5 to 12 minutes. Thanks to constant change of body support and massage, blood circulation and tissue nutrition improves. Such mattresses are suitable for preventing tissue necrosis and treating the initial stages of this process. Also, these products are suitable for patients whose weight does not exceed 120 kilograms.
Patients who have bedsores of the second, third and fourth stages should purchase tubular mattresses. Such devices are also recommended for those people who weigh more than 120 kilograms. The products consist of hollow tubes arranged transversely, which are alternately filled with air. The increased size of the chambers, compared to a cellular mattress, promotes more effective tissue massaging and reduces pressure on the affected areas.

Airflow system

Compressor type

Dimensions and maximum permissible weight of the mattress

In order to understand the best way to treat bedsores, you need to have an idea of ​​the causes of this problem. What causes damage to the skin and underlying tissues in bedridden patients?

Reasons for the development of bedsores

The key factor is pressure of the hard surface on which the patient is located on protruding areas of the body. Most often, injuries occur in areas such as the sacrum, thoracic spine, shoulder blades, back of the head, heels (in situations where a person lies on his back) - it is in these areas between the bone tissue and skin that there is a very small layer of muscle and fatty tissue.

When the patient lies on his side, the greatest pressure falls on the areas greater trochanter femur, ilium. In the prone position, the tissues in the areas of the protruding iliac bones and chest are damaged. In sedentary patients, the risk of injury is higher in the area of ​​the ischial tuberosities, sacrum, heels, fingers, feet, and shoulder blades.

Why does pressure cause damage to tissue?

• Blood vessels are compressed, ensuring the delivery of oxygen and nutritional components to skin and muscle cells. Oxygen starvation (hypoxia) and nutritional deficiency lead to inhibition of cell activity and its death;
• Nerve fibers are compressed, regulating metabolism in tissues: which, in turn, negatively affects cell viability
• Lymphatic vessels are compressed, responsible for removing cell waste products from the intercellular space, waste and poisons begin to accumulate, reducing the viability of cells and leading to their death as a result of poisoning. The lymphatic system is also responsible for the removal (disposal) of dead cells: compression of the lymphatic vessels leads to the accumulation of dead cells in the tissues - and this creates favorable conditions for the development of infection

Stages and types of bedsores

In the process of caring for a bedridden patient, it is very important to know what types and stages of damage there are when it comes to such a problem as bedsores in bedridden patients, and the question arises - how to treat it at home? In the photo you can see what bedsores look like in various stages.

There are four stages of development of pressure ulcers:

It is very important to notice the first signs of damage development in time, best when they are still reversible. In a situation such as bedsores, the initial stage, minimal treatment is required. The photo shows that there is no damage to the skin yet, and it is enough to eliminate the harmful factors to stop the dangerous process.

Bedsores are also divided into exogenous - caused primarily by external factors, endogenous - their occurrence is associated primarily with disorders within the body, and mixed - appear under the influence of both external and internal factors.

Endogenous bedsores very often occur in patients with disorders of the nervous system (traumas and tumors of the brain and spinal cord, cerebral hemorrhages), as well as with metabolic disorders (for example, diabetes mellitus). In this case, disorders of the nervous regulation of metabolic processes in tissues occur, so the development of damage often occurs from the inside out: that is, damage to muscle tissue develops first, and only then signs on the skin become noticeable.

When it comes to a problem such as bedsores, treatment at home should be comprehensive and include the following areas:

• Measures to eliminate the factors that caused the development of bedsores,– pressure, friction, displacement, excessive moisture;
• Local treatment, which (depending on the stage) can be aimed at improving blood circulation in the affected area, eliminating irritation, fighting infection with local funds, acceleration of healing processes, etc.
• Taking general and systemic drugs(orally, intramuscularly, intravenously), aimed at fighting infection, improving metabolic processes, blood circulation, etc.
• Treatment of the underlying disease, which led to limited mobility and caused the development of bedsores (especially important in the case of endogenous bedsores resulting from internal disorders).

In general, treatment tactics are determined by the stage of the process and the depth of tissue damage, as well as the presence of infectious complications.

Measures to eliminate the factors that led to the development of bedsores

How to reduce pressure on tissue to avoid cell death (in the initial stage) and prevent the spread of necrosis to deeper tissues? To solve this problem, the following measures are proposed:

• regular changes in the patient’s body position;
• use of special circles and pillows;
• use of anti-decubitus mattresses.

Changing body position

Regularly changing the body position of a bedridden patient can reduce the load on areas subject to the greatest pressure. This makes it possible not only to avoid progression of the process with existing bedsores, but also to prevent the appearance of new damage.

The Protocol for the management of patients with pressure ulcers (recommendations of the Ministry of Health of the Russian Federation for the treatment and prevention of pressure ulcers) states that in areas of increased risk of developing injuries (which we discussed above) changes in tissues leading to cell death can begin after just two hours of continuous pressure. This is especially true for patients with injuries and diseases of the nervous system, metabolic and vascular disorders. Because in such situations, the effect of an external factor (pressure) is aggravated by the influence of internal factors (tissue nutritional disorders).

That is why it is recommended to change the body position of a lying patient at least every two hours throughout the day (including night time). There are several special positions that minimize pressure on tissue in risk areas: the Sims position, the side-lying position, the prone position, and the Fowler position. Certain techniques have been developed for moving a bedridden patient to each of these positions:

Move to Sims position

Moving to the side-lying position

Moving to the “Lying on your stomach” position

Placement in Fowler's position

This position allows the recumbent patient to be in a semi-sitting position, which makes breathing, eating, communication easier and is psychologically comfortable for him. To place the patient in this position, a bed with a raised head end (functional bed) is best suited, but special pillows can be used.

1. The patient is moved to the supine position: you can choose a position at an angle of 45 (low Fowler position) or 60 (high Fowler position) degrees;
2. Pillows are placed under the patient’s head, lower back, elbows, hips, and lower third of the leg.
3. A support is placed under the patient’s feet to prevent the patient from sliding, which leads to tissue displacement in the sacral area.

With each movement, it is recommended to examine the patient’s body both in the area of ​​existing bedsores (to assess their condition) and in areas where there is a risk of new injuries. The video will help you get acquainted with the algorithm of actions when changing positions of a bedridden patient:

It is most convenient to carry out manipulations to change the body of a patient located on a functional bed specially adapted for the care of patients with limited mobility.

Purchasing a functional bed for caring for a bedridden patient at home seems especially appropriate when it comes to patients bedridden for a long time (months and years). When placing a patient on a regular bed, a number of conditions must be met.

The Protocol for the care of patients with pressure ulcers indicates inadmissibility of placing the patient on a bed with armored mesh or a mattress that causes areas of the patient’s body to “sag” (which impairs blood circulation), making it more difficult to care for the patient, change body position, etc. It is also important that the bed is not too low: it is optimal if the patient is at the level of the middle thighs of the person performing care. A position that is too low makes manipulation difficult and can lead to errors in care.

Using special pillows

A pillow and a circle for bedsores are devices that help reduce pressure on tissues in areas of increased risk of developing damage, avoiding friction and tissue displacement. In addition, they create a more comfortable bedside environment for patients with limited mobility.

We have already mentioned how pillows are used for bedridden patients against bedsores in different positions of the patient in bed. Now let’s take a closer look at the types of pillows and circles, talk about which products are best to choose and how you can make such devices with your own hands.

Pillows differ in shape, material from which the surface is made, and also filling. What types of pillow shapes are there?

Surface of pillows It can be flat (smooth) or have a certain relief - rough, cellular, etc. In the second case, in addition to the effect of reducing pressure on the area of ​​​​the bedsore (or the place of its potential development), the blood supply in the risk zone is stimulated: a kind of micro-massage is performed.

Types of fillings for pillows: foam rubber, latex, gel, foam (polyurethane foam). Can also be used as a filler air(inflatable pillows). When using them, you can control the amount of injected air, and, therefore, the degree of elasticity. Such pillows can consist of one section or of many cells connected to each other. In the second case, air flows from one cell to another, which creates opportunities for uniform pressure distribution.

On the Internet you can find information about the use of such fillers as millet, flax, buckwheat, etc. in pillows. For example, it is believed that they can be used to make such a device as a bedsore pillow with your own hands. However, unlike gel, foam, latex and other fillers, which have the ability to reduce and redistribute pressure and take the shape of the patient’s body, fillers made from cereals and seeds are very hard and do not adapt to the contours of the patient’s body. As a result, their use may increase pressure in risk areas, increasing the risk of injury.

Bedsore circles can also be used to relieve pressure - the photo shows that they come in different sizes. Circles with a diameter of up to 30 centimeters are intended for placing under the head, elbows, shins, and heels. To prevent damage to the buttocks and tailbone area, a circle with a diameter of 40 cm is suitable. Circles with a larger diameter are intended for use in obese patients.

Bedsore pads are made of rubber; air is used as a filler, and less often, water. It is recommended to place them in a pillowcase or under a sheet before use to avoid irritation where the skin comes into contact with the rubber.

Sometimes relatives caring for a bedridden patient ask the question - how to make a circle for bedsores with your own hands? In reality, it is quite difficult to make a rubber circle yourself. It is not advisable to use gauze or fabric to make it (such recommendations can be found on the Internet), since these dense materials can increase pressure at the points of contact with the skin and lead to new damage.

Anti-bedsore mattresses for bedridden patients

An anti-bedsore mattress is considered an effective means of preventing and treating tissue damage in bedridden patients. Exist different kinds mattresses, the choice depends on the degree of tissue damage, the severity of the patient’s condition, his weight, etc.

For example, you can use foam mattresses, the recommended thickness is 10 cm. A foam mattress is one of the so-called static mattresses for bedsores. They contribute to the uniform distribution of the patient’s body pressure over the surface, but do not have a noticeable additional effect on the tissues. From modern materials For the manufacture of static mattresses, the same materials are used as for pillows - foam, gel, latex.

It is considered more effective to use the so-called dynamic mattresses– their use is recommended for patients with existing bedsores, a high risk of their development, for patients whose mobility is limited for a long time. Such mattresses not only help to evenly distribute body pressure, but also provide a constant additional massage effect on the tissue.

The filler for dynamic mattresses is air - it is pumped into them using a special compressor, which is attached to the mattress. The amount of air depends on the patient’s body weight - the heavier the patient, the less air should enter the mattress, otherwise elasticity will decrease, air will not be able to move freely through the compartments, and pressure on the tissue will increase. Dynamic mattresses are not placed directly on the bed, but are placed on top of the main mattress.

There are two types of dynamic mattresses: cellular and balloon. Cellular mattress against bedsores consists of many small compartments - cells, between which air can move freely. This mattress is a suitable option for patients who are not obese and with minor tissue damage (stage 1-2).

In balloon (or tubular) mattresses air is pumped into cylinders (sections) located transversely to the patient’s body. There is an alternating change in pressure in each section, which provides a massage effect and improves blood circulation in the tissues. Balloon mattresses are suitable for patients with large body weight (usually Weight Limit the patient for whom the mattress can be designed is indicated in its characteristics), as well as with stage 3-4 bedsores.

Reduce friction– an important task when caring for patients with pressure ulcers. In order to avoid additional tissue injury, it is necessary:

• Correctly change bed linen (do not pull the sheet from under the patient, but lift him above the bed or roll the patient onto a clean sheet);
• Avoid friction when performing hygiene procedures, do not use bar soap, replacing it liquid means. At the end of the procedures, dry the patient's skin by blotting.
• Regularly inspect the patient's bed, eliminate folds in bed linen, crumbs and other foreign objects.
• Ensure that the patient’s clothing is free of buttons and rough seams. which can injure the skin.

Measures for eliminating excess humidity, which also increases the risk of developing pressure ulcers, should include:

• Usage bed and underwear made of cotton fabrics ensuring sufficient gas exchange. Underwear made from synthetic fabrics increases sweating and increases skin moisture;
• Usage disposable diapers with urinary and/or fecal incontinence. Diapers must be changed every four hours (regardless of the frequency of urination), as well as immediately after bowel movements (bowel movements), followed by hygiene measures;
• Maintaining the room where the patient is located optimal microenvironment– the air temperature should not exceed 18-20 degrees Celsius, because the patient's stay in a hot room promotes sweating and increases skin moisture.

How are bedsores treated in bedridden patients at home? The choice of agents that have a local effect on the affected area depends on the stage of the process, the depth and extent of necrosis (the area of ​​cell death), as well as the presence of purulent complications.

So, if we are talking about a problem such as bedsores (stage 1), treatment should be based, first of all, on eliminating the factors that caused the damage: measures related to reducing pressure, humidity, and friction have already been mentioned earlier. Since at the initial stage the integrity of the skin is not compromised (the vital activity of cells is inhibited, but death has not yet occurred), the risk of developing infectious complications is low, the use of healing agents and topical antibiotics will not be relevant. To achieve a favorable result - preventing cell death - the use of drugs that activate blood circulation in the damaged area will help.

When cell death occurs (necrotic changes) and there is a violation of the integrity of the skin (stage 2 bedsores), treatment should include topical drugs that stimulate tissue repair (regeneration), anti-inflammatory drugs, local antibiotics, etc.

It is important to remember that before using this or that medicine for bedsores for bedridden patients, you must consult with your doctor.

The table below presents various drugs for bedsores for bedridden patients (local action) and also indicates the goals to be achieved by the use of these drugs. The information provided corresponds to the recommendations of Dr. med. Professor M.D. Dibirov (Department of Surgical Diseases and Clinical Angiology of A.I. Evdokimov Moscow State Medical University).

Also, one of the tasks that the treatment of necrosis of the skin and soft tissues with medications should be aimed at is the elimination of excess fluid that forms as a result of inflammation in the pressure wound. For this purpose, ointments containing zinc can be prescribed. These agents help reduce inflammatory manifestations, “dry” the wound, and have some antimicrobial effects.

In the work “Bedsores. Prevention and treatment” Professor M.D. Dibirov points out that already in the early stages of development of the injury, it is necessary to clean the injury site daily (rinse the area where the bedsore occurs) in order to reduce the risk of infection. However, for these purposes It is not recommended to use products containing iodine and chlorine(including alcohol solution of iodine, chlorhexidine, etc.).

This is due to the fact that these drugs act aggressively, disrupt the permeability of cell membranes, exacerbating metabolic disorders, and can also destroy immune cells that have migrated into the wound to destroy foreign microbes. According to the professor, it is recommended to use ordinary saline solution to treat the wound (it can be prepared at home: 1 tsp of salt per 1 liter of water). After finishing the treatment, the damaged area must be thoroughly dried (by blotting, without rubbing).

Dressings for bedsores

Also Professor M.D. Dibirov believes that for a problem such as bedsores (initial stage), it is recommended to include the use of bandages in treatment. For minor damage, the best option is polyurethane film dressings, which have a “second skin” effect: they do not block air access to the affected area and do not prevent the evaporation of moisture from the surface of the skin. At the same time, such dressings provide protection from mechanical damage and from external pathogens. They are transparent, which makes it possible to observe changes in the damaged area without injuring the wound.

Bandages are effective remedies for bedsores at home, especially those that, in addition to the main effect (protection from damage and infection), have additional medicinal properties, – so-called interactive dressings.

When deciding how to treat bedsores at home using bandages, you must remember that the use of traditional dressings (gauze, bandages) is not recommended, as they can increase skin damage due to friction. They have the ability to “stick” to the wound, which will lead to additional injury during dressing.

In addition to the use of local remedies, the attending physician may prescribe one or another medicine for bedsores at home, which has a general effect on the body. First of all, we are talking about drugs whose action is aimed at treating the underlying disease. This is especially true for situations where the occurrence of damage to the skin and underlying tissues is caused not only by external, but also by internal factors, which were mentioned above.

Drugs may be prescribed that improve metabolic processes in nerve and muscle tissue, stimulate blood circulation, vitamin complexes. The use of B vitamins, as well as ascorbic acid - vitamin C, is especially important.

It is also important to understand that pressure wounds are an entry point for pathogenic microbes. If an infection occurs, the doctor may prescribe antibiotics for bedsores orally (orally, intramuscularly, intravenously) along with local antibacterial agents.

It is necessary to remember what about a problem like purulent bedsores, treatment at home may be unsafe. Many bedridden patients have a weakened immune system, so the infection quickly spreads to surrounding tissues, leading to inflammation in other organs. In addition, there is a high risk of developing sepsis (blood poisoning) - a deadly complication!

Therefore, only the attending physician can correctly determine the tactics for managing a patient with bedsores in the event of a soft tissue infection: antibiotics (for local and general treatment), hospitalization of the patient, surgical intervention - the sooner adequate measures are taken to treat infectious complications, the higher the likelihood of a favorable outcome.

When answering the question “how to cure bedsores in a bedridden patient at home,” you must remember the role of good nutrition as important condition solutions to this problem. Thus, for the restoration processes (regeneration) of tissues to occur in the damaged area, that is, the construction of new cells, a sufficient amount of protein must be supplied to the body.

In addition, people forced to lead a sedentary lifestyle develop muscle atrophy - a decrease in the mass and volume of muscle tissue, which leads to a further decrease in overall tone, progression of microvibration deficiency, etc. Protein foods will provide the body with the building materials necessary for tissue repair.

According to the Protocol for the management of patients with pressure ulcers, the diet of a patient with limited mobility should include at least 120 g of protein daily, which can be obtained from both animal (meat, fish, poultry, milk and dairy products) and plant (nuts, legumes, etc.) products.

It is also important that the diet is rich in vitamins, primarily vitamin C, which is necessary for the full functioning of the immune system (which is important for the prevention of infectious complications). Recommendations for the management of patients with pressure ulcers indicate that The daily dosage of ascorbic acid (vitamin C) should be 500-1000 mg. The following foods are richest in this vitamin:

• Rosehip (1000 mg/100 g)
• Sweet pepper (250 mg/100g.)
• Sea buckthorn (200 mg/100g)
• Blackcurrant (200 mg/100g.)
• Kiwi (180 mg/100g)
• Brussels sprouts (100 mg/100g.)

Massage for bedsores

In the television program of the famous doctor Elena Malysheva, massage is considered as a means of preventing the occurrence of bedsores. This measure is also relevant for patients with existing injuries, since the presence of a lesion in one area leads to an even greater limitation of mobility and contributes to the development of new lesions of the skin and soft tissues. To stimulate blood circulation, it is recommended to rub the patient’s body daily with a hand in a special mitten on which camphor alcohol (10%) is applied.

The Protocol for the Management of Patients with Pressure Ulcers also considers massage as a preventative measure for the development of new lesions. However, it is indicated that massage cannot be performed in the area of ​​​​bone protrusions; it is necessary to limit massage movements around these areas. Also, under no circumstances should massage be performed in areas where there are already violations of the integrity of the skin and underlying tissues.

Phonics is an effective method for treating bedsores

The effectiveness of using vibroacoustic therapy is associated with its ability to increase the overall microvibration background in the body. A patient forced to lead a sedentary lifestyle suffers from a severe deficiency of microvibration of muscle cells associated with lack of movement, which leads to disorders in all organs and tissues. Vibroacoustic therapy is a unique opportunity to saturate the body with the most valuable resource when there is a lack of movement.

What problems can be solved using Vitafon devices for patients with limited mobility?

• Improve blood circulation all areas of the body, including the skin and muscles in the area where bedsores develop. At the same time, metabolic processes in tissues are activated, cell nutrition and oxygen supply are improved, which reduces the risk of their death;
• Stimulate the processes of removal (disposal) of dead and damaged cells, which are the environment for the development of infection, from the necrosis zone. This reduces the risk of purulent complications and creates conditions for tissue renewal (regeneration) in the bedsore area;
• Remove poisons and toxins from the body, formed as a result of the death and disintegration of cells and pathogenic microbes, which has beneficial effect for the work of the whole organism;
• Activate general and local immunity by improving the functioning of the lymphatic system, which also reduces the likelihood of infectious complications in patients with bedsores;
• Increase the overall microvibration background of the body, which will have a beneficial effect on the course of the underlying disease, prevent further decrease in the volume of muscle tissue, and increase the overall tone of the body.

The optimal solution for a bedridden patient would be to use a vibroacoustic mattress (composed of ). The 8 vibraphones included in its composition provide a simultaneous impact on the area of ​​​​bedsores and surrounding tissues. The device can operate in automatic mode for up to 14 hours, providing the body with continuous and dosed exposure - automatic activation occurs for 3 minutes every 24 minutes.

Thus, in order to understand how to treat bedsores in bedridden patients at home, it is necessary to know the causes of the development of these injuries and understand the features of caring for patients with limited mobility.

The main task is to notice in time the first signs of the development of damage to the skin and underlying tissues and take the necessary measures to prevent further development of the process and the occurrence of dangerous complications. Stage 1 and 2 pressure ulcers are characterized by minimal tissue changes, which are quite easy to deal with. It is enough to carry out a number of activities, including:

• Proper care, which involves eliminating the causes of bedsores: regularly changing the patient’s position in bed, timely toileting of the skin, etc.
• The use of special means to help prevent the development of bedsores: mattresses, pillows, circles.
• Vibroacoustic therapy() for resource support of the body.
• Proper nutrition(sufficient amount of protein and vitamins)
• Regular massage.
• Local treatment is the use of drugs with antibacterial, healing properties, etc., as well as special dressings.
• Taking general medications, including (if necessary), antibiotics as prescribed by a doctor.

At the same time, treatment of grade 3 bedsores, in which there is muscle damage, as well as grade 4, affecting the deep layers of tissue down to the bone, while the patient is at home, can be quite difficult and not give the desired effect. This is associated with a high risk of infectious complications, including the development of sepsis (blood poisoning). In order to promptly detect danger and take the necessary measures, such a patient must be constantly under the supervision of a doctor.

Therefore, if the process has gone far, you should not think about how to treat deep bedsores at home, but you need to contact your doctor as soon as possible, who can decide whether to hospitalize the patient. The presence of extensive and deep wounds (stage 3-4) is often an indication for surgery: the surgeon removes dead areas of skin, muscles, bones, and fills the resulting defect with tissue (flaps of skin, connective tissue and muscles), which are taken from other parts of the patient’s body .

It is especially important to take timely measures when it comes to patients with damage to the nervous system, metabolic and vascular disorders. In such cases, complications can develop quite quickly. Therefore, if, despite treatment at home, healing does not occur and the process continues to progress, you need to seek help!

How to cure bedsores at home? It will help to achieve a positive effect in the treatment of skin and soft tissue lesions in bedridden patients. vibroacoustic therapy. Application allows you to have a local effect on the affected area, preventing the aggravation of the process and the addition of infectious complications. Also, saturating the body with healing energy helps cleanse the body of dead cells, toxins and poisons, improves blood circulation and metabolic processes in tissues, strengthens the immune system and gives strength to fight both the underlying diseases and the changes underlying the development of bedsores.

List of used literature:

1. Baskov A.V. Features of surgical treatment of bedsores of different localization / Research Institute of Neurosurgery named after. Academician N.N. Burdenko, M, 2002
2. Dibirov M.D. Bedsores. Prevention and treatment / Medical Council, No. 5-6, 2013.
3. Vorobiev A.A. Treatment of bedsores in spinal patients / Bulletin of the Volgograd Scientific Center of the Russian Academy of Medical Sciences. – 2007 – No. 2.
4. Klimiashvili A.D. Prevention and treatment of bedsores / Russian Medical Journal. – 2004 – T. 12, No. 12.
5. / “Doctor” No. 7 / 2014
6. Patient management protocol. Bedsores. /Appendix to the order of the Ministry of Health of Russia dated April 17, 2002, No. 123.
7. Fedorov V.A., Kovelenov A.Yu., Loginov G.N. and others / St. Petersburg: SpetsLit, 2012.

You can ask questions (below) on the topic of the article and we will try to answer them competently!

The topic of the article is the classification of bedsores, how to recognize the different stages of bedsores in time, what types and degrees of bedsores exist. This information will help you respond to danger in a timely manner and contact a specialist to properly solve the problem.

It can be difficult for relatives caring for a bedridden or sedentary patient to understand what kind of lesion we are talking about and what measures need to be taken. After all, a bedsore refers to both minor damage to the skin, which can be eliminated with proper care, and deep ulcers on the body that pose a threat to life.

Classification of bedsores

Causes and risk factors for the formation of bedsores

The main reason for the formation of bedsores is a person’s prolonged stay in a stationary position. Limitation of mobility may result various situations: injuries, diseases that limit mobility, severe exhaustion, mental illness, coma, etc. Damage to the skin, and then soft tissues, primarily occurs in “bulging” areas of the body, in which there is a very thin layer between the bone tissue and the skin layer of fiber (fat tissue) and muscle.

If the patient lies on his back, bedsores most often form in the area of ​​the sacrum, coccyx, thoracic spine, heels, and less often in the back of the head and shoulder blades. In the prone position, the knees and the area of ​​the iliac bones (protruding areas) are more often affected. pelvic bone), protruding surface of the chest. In the lateral decubitus position, tissues most often affected are the greater trochanter of the femur and the iliac crest. In sedentary patients, lesions often develop in the area of ​​the closure of the buttocks, tailbone, and heels.

How does a bedsore occur? In the area that is subject to pressure, blood circulation is impaired, causing cells to begin to suffer from a lack of oxygen and nutrients. Also, due to compression of the lymphatic vessels responsible for removing waste products from cells, waste and poisons begin to accumulate, poisoning the internal environment of the cell.

In addition to pressure, factors such as friction, tissue displacement, and moisture play an important role in the development of damage to the skin and underlying soft tissues - you can read more about this. If the influence of the factors causing this entire cascade of damage does not stop, the cells begin to die - tissue necrosis (death) develops, spreading to the skin, subcutaneous fat and muscles.

The risk of developing pressure ulcers also depends on many other factors. Thus, in the Industry Standard " Patient management protocol. Bedsores", developed by the Ministry of Health of the Russian Federation, proposes a scoring system (Waterlow scale) for assessing the risk of developing pressure ulcers depending on age, gender, the presence of concomitant diseases in the patient, etc. The table below presents some of these criteria:

There are also types of pressure ulcers that occur as a result of pressure and friction from a cast (or other fixation material), vascular or urinary catheter. In addition, one of the most important reasons for the development of damage to the skin and soft tissues in sedentary patients is low level. The microvibration background of the body is created due to contractions of muscle cells, which are recorded not only during physical activity, but even at rest and sleep. This valuable resource is as important to sustaining life as air, water, food and heat. It is necessary for metabolic processes in cells and the directed movement of substances through blood and lymphatic vessels.

A sufficient level of microvibration is also needed for the full functioning of the lymphatic system, on which the condition of the body depends, the ability of the body to get rid of toxins, poisons (formed as a result of the vital activity of cells, the death of microbes, etc.), as well as. Maximum saturation of the body with microvibration energy occurs through physical activity - sports, walking, swimming, etc.

People who, for some reason, are deprived of the ability to move actively, and especially patients confined to a bed or wheelchair, develop a pronounced deficiency of microvibration energy in the body. What disorders that contribute to the development of bedsores does this lead to?

• The functioning of blood vessels suffers, which disrupts the delivery of nutrients and oxygen to tissues (including skin and muscle cells).
• Metabolic processes are disrupted in the cells, poisons and waste begin to actively accumulate, which accelerates cell death. Due to disruption of the lymphatic system and other organs (liver, kidneys) responsible for the processes of removing metabolic products from the body, which is also associated with a deficiency of microvibration, poisons and toxins accumulate. This leads to poisoning of the body, decreased organ function and the creation of a favorable environment for the development of pathogenic bacteria.
• Deterioration of the lymphatic system leads to decreased immunity, which also increases the risk of developing infectious complications.

Thus, a deficiency of microvibration accelerates the process of death of skin and muscle cells in patients, promotes the accumulation of dead cells, toxins and poisons in the body, increases the risk of infection: all this creates conditions for the development and progression of bedsores in bedridden patients.

The situation is aggravated by the fact that muscle cells, deprived of the ability to move, begin to decrease in size (atrophy), muscle mass becomes less and less, which leads to a further decrease in the level of microvibration in the body. In this situation, essential support for the body is - about its role in treatment And prevention of bedsores will be discussed further.

What are the stages of development of bedsores? In domestic and foreign medicine, there are different classifications, which are based on different criteria for assessing bedsores - external manifestations and symptoms, depth of tissue damage, cause of occurrence, presence of complications, etc.

The Protocol for the management of patients with pressure ulcers, a key document that all medical institutions in the Russian Federation are guided by, presents a classification that describes the symptoms of pressure ulcers at each stage. This classification is sometimes called dynamic. This definition implies that the dynamics of the process, that is, the transition from one phase to another, is not at all obligatory and immutable, but depends on many reasons and, above all, on proper care (especially in the initial stages). Also, timely resource support for the patient plays an important role - increasing the level of microvibration in the patient’s body.

According to the Protocol, there are 4 stages of pressure ulcers: below is a table that reflects this classification.

To better understand what bedsores look like, you can look at the photo: the initial stage is characterized by the presence of a focus of redness, the skin is not damaged, as oxygen deprivation increases, the skin acquires a bluish tint (the development of cyanosis)

What do bedsores (stage 2) look like in photographs? Here we observe violations of the integrity of the skin - from peeling to the formation of a superficial wound.

In stage 3, the wound becomes deeper and muscle tissue may be visible. What do stage 4 bedsores look like? Views in photographs deep wounds, at the bottom of which bones, ligaments, and tendons may be visible.

Classification by stages of the pressure ulcer process

Professor M.D. Dibirov (Department of Surgical Diseases and Clinical Angiology of the A.I. Evdokimov Moscow State Medical University) also talks about the classification of pressure ulcers, focusing on the stage of the pressure ulcer process. In total, there are three stages: in order to understand what bedsores look like in each of them, you can look at the photos by stage.

Stage I – stage of circulatory disorders (vascular disorders)

This stage is characterized by changes caused by impaired blood circulation in the tissues. First, the skin becomes pale at the point of pressure, which is replaced by redness, then the skin acquires a bluish tint. What do bedsores look like in the initial stages? The photo shows areas of redness without clear boundaries, the integrity of the skin is not compromised.

Stage II – stage of necrotic changes and suppuration

At this stage, cell death (necrosis) occurs with damage to the skin and underlying tissues: fiber, muscles. At this stage, an infection may occur that affects both soft tissue (skin, subcutaneous tissue, muscles) and bone and joint tissue.

A bedsore at this stage may look like a superficial wound or a deep ulcer, in some cases having a dry surface and clear edges, in others there is purulent discharge and blurred edges, which indicates the spread of the process to the surrounding tissues.

Stage III – healing stage

At this stage, tissue regeneration (restoration) processes prevail in the area of ​​the bedsore, the wound heals - the integrity of the skin is restored or a scar is formed.

Classification of bedsores by mechanism of occurrence

Also in medical practice, a classification is used, which is based on the division of pressure ulcers into groups, taking into account the mechanism of their occurrence. In this case, the role of the influence of external causes and internal disorders that play a role in the development of the damage we are talking about is taken into account

There are three types of pressure ulcers: exogenous, endogenous and mixed.

1. Exogenous bedsores– damage, the occurrence of which is associated primarily with external influences (from the Greek exo - outside, genes - generated). First of all, we are talking about damage to the skin and underlying tissues that develop under the influence of factors that have already been mentioned above: pressure (as a key factor), friction, sliding, humidity. In turn, exogenous bedsores are divided into external and internal:
   • External exogenous bedsores- these are the same injuries that develop from contact of the most protruding areas of the body (for example, the sacrum, shoulder blades, heels in the “supine” position) with a hard surface. This group also includes injuries resulting from pressure and friction of plaster casts (and other materials used for fixation in case of injuries), various corsets, poorly selected prostheses, etc.
   • Internal exogenous bedsores – areas of damaged skin that appear as a result of constant pressure from catheters - tubes inserted into blood vessels to facilitate the administration of drugs, into the urinary canal or bladder for urine drainage. As a rule, they develop in patients with metabolic disorders, exhaustion, and problems with blood supply to tissues.
2. Endogenous bedsores(from the Greek endo - inside) are associated primarily with internal violations in organism. Most often, such injuries occur in patients with lesions of the brain and/or spinal cord. This could be an injury, stroke (hemorrhage), tumor, etc. Such diseases lead to disruption of the nervous regulation of metabolic processes in tissues, disruption vascular tone. As a result, the nutrition of cells, including muscles and skin, suffers, which is the main reason for the development of damage. Such bedsores are often called neurotrophic ulcers (from the Greek trophe - nutrition).

   The main danger of such lesions is that the death of muscle cells and the development of ulcers in muscle tissue often occurs when the skin is intact. Thus, it can be difficult to recognize and take adequate measures to treat them in time - ultrasound examination of soft tissues may be required to diagnose them. That is why patients with diseases and injuries of the nervous system need constant medical supervision.

3. Mixed pressure ulcers develop when the body has internal problems (for example, exhaustion, cancer), as a result of which the regulation of tissue nutrition and metabolic processes suffers, and there are external influences - pressure, friction, etc.

The tactics of their treatment depend on what factors (external or internal) are associated with the formation of bedsores. So, if external causes play a leading role, then the problem (especially in the early stages) can be solved with the help of proper care and well-chosen medications for local use.

Why is it important to understand what causes damage? Because patient management tactics depend on this. If the problem is primarily related to diseases and injuries of the nervous system, metabolic disorders caused by various diseases, etc., then priority measures should be aimed at improving tissue nutrition, nerve conduction, normalizing metabolism, restoring blood supply to tissues, etc. If external causes play a leading role, then the problem can be solved (especially in the early stages) with the help proper care and well-chosen medications for local use.

At the same time, when we are talking about running processes (these are the third and fourth stages), then, for whatever reason, damage occurs, in order to eliminate them, in most cases it is necessary surgery. Besides, All patients suffering from bedsores are recommended vibroacoustic therapy, providing the body with a resource. In this case, the cause of the problem also does not matter.

Classification of bedsores by type of necrosis (cell death)

When, as a result of certain reasons, cells begin to die at the site of the development of a bedsore, an area of ​​necrosis (dead tissue) appears. However, in different cases this process develops differently:

• Dry necrosis(mummification) is the “drying out” of the affected tissues. The lesion has clear boundaries, there is no discharge from the wound: infection occurs very rarely, in the initial stages, when a certain amount of fluid remains in the tissues. The patient may notice pain in the affected area, but the general condition most often does not suffer.
• Wet necrosis(bedsore gangrene) often develops in weakened patients with lesions of the nervous system, metabolic and vascular disorders. In this case, tissue necrosis occurs over large areas, and the damaged area often becomes infected. The wound is swollen, purulent discharge with an unpleasant odor is found in it.

  As a rule, the development of pressure ulcer gangrene is accompanied by a sharp deterioration in the patient’s general condition: an increase in temperature, delirium, loss of consciousness, palpitations, and vomiting may be observed (as a consequence of poisoning of the body with microbial decay products). In the absence of adequate measures (prescription of antibiotics, surgical treatment), there is a high probability of developing sepsis - blood poisoning, often leading to the death of the patient.

Classification of pressure ulcers by size (diameter of lesion)

• Small bedsore: diameter less than 5 cm.
• Average bedsore: diameter is 5-10 cm.
• Large bedsore: diameter is up to 10 to 15 cm.
• Giant bedsore: diameter exceeds 15 cm.

It should be noted that a large diameter of a bedsore does not always indicate the presence of a severe process: extensive lesions can sometimes be superficial, occur without infectious complications and respond quite well to treatment without surgery. Of course, this picture is more common when it is not advanced bedsores that are observed, but the initial stage of the process.

At the same time, an ulcer with a relatively small diameter can be quite deep, reach the muscle layer and serve as an entry gate for infection. A similar picture is often observed in patients with damage to the nervous system and blood vessels.

In this case, the so-called fistulous form of bedsore - the entrance hole (ulcer) in the area of ​​the skin has a minimal diameter (less than 1 cm), it is a canal that leads into a deep cavity with purulent contents located underneath. Moreover, not only muscles, but also bone tissue can be involved in the inflammatory process with the development of osteomyelitis.

Classification of bedsore complications

Bedsores in patients are often complicated by the addition of an infectious process, especially when it comes to stages 3-4 (the presence of a deep ulcer with damage to muscle tissue). If the patient is in a hospital, there is a high probability of developing inflammation caused by a nosocomial infection, that is, pathogens that are resistant to the action of many antibiotics. When making a diagnosis in the case of complicated pressure ulcers, in addition to the stage of the process, the type of complication is indicated.

Depending on which tissues are involved in the inflammatory process, there are the following types infectious complications of bedsores:

• Phlegmon– inflammation of subcutaneous fatty tissue, connective tissue, which does not have clear boundaries. Most often caused by staphylococcus.
• Abscess- a focus of purulent melting of soft tissues (fiber, connective tissue, muscles) with the formation of a purulent cavity, which has clear boundaries.
• Osteomyelitis– melting of bone tissue. More often it occurs in areas such as the coccyx, sacrum, back of the head, and heel bones.
• Suppurative arthritis– inflammation in the joint area.
• Purulent melting of the vascular wall– can lead to both bleeding and the entry of purulent contents into the bloodstream.
• Sepsis– spread of infection throughout the body, in which case the formation of purulent foci may occur in various organs (heart, kidneys, lungs, joints, etc.) with the development of inflammatory processes in them. The entry into the blood of a large number of toxic (harmful) substances associated with mass death and the decay of cells, living and dead microbes and their metabolic products can very quickly cause the death of the patient.

It is also possible to develop complications such as erysipelas associated with the penetration of streptococci into the pressure wound. In some cases, in the presence of long-term non-healing ulcers, especially in patients with diseases of the nervous system and metabolic disorders, it is possible malignant degeneration (malignancy) and development of skin cancer at the site of a bedsore (Sh.M. Chyngyshpaev, 2013).

Bedsores do not always develop in patients in the hospital. Often, relatives care for a patient with limited mobility at home. What should you do if you discover the damage that we are talking about in this article?

First of all, it is necessary to call a doctor who can competently assess the condition of the skin and soft tissues at the site of development of the lesion and, if necessary, decide to send the patient to the hospital.

But this is not always necessary. For example, bedsores in which there is no deep tissue damage (as a rule, we are talking about the first and second stages) and there are no signs of an infectious process can be dealt with at home. In this case, the most important role is played by the organization of proper patient care, a rational diet and drinking regime, the formation of a favorable microclimate in the room where the patient is, the use of local medications, etc. You can read more about this in the article “ How to treat bedsores in bedridden patients at home?».

An effective means of treating and preventing bedsores is. Use in people with limited mobility helps to increase levels in the body and solve the following problems:

• Activation of metabolic processes in all organs and tissues, including skin and muscles.
• Improving blood supply to all tissues of the body.
• Stimulation of the process of removal (disposal) of dead cells, toxins and poisons due to improved functioning of the lymphatic system and other organs responsible for cleansing the body (kidneys, liver)
• Strengthening the immune system, thereby significantly reducing the risk of developing infectious complications.

List of used literature:

1. Baskov A.V. Surgical treatment of bedsores in patients with spinal cord injury / Issues of neurosurgery - 2000 - No. 1
2. Vorobiev A.A. Treatment of bedsores in spinal patients / Bulletin of the Volgograd Scientific Center of the Russian Academy of Medical Sciences - 2007 - No. 2
3. Garkavi A.V. Complex treatment of bedsores in spinal patients. Dissertation of Candidate of Medical Sciences / Moscow, 1991.
4. Dibirov M.D. Bedsores. Prevention and treatment / Medical Council, No. 5-6, 2013.
5. Zilovich A. A. Surgical treatment of bedsores, trophic ulcers and osteomyelitis in patients with injuries of the spine and spinal cord. Dissertation of Candidate of Medical Sciences / Donetsk, 1986.
6. Klimiashvili A.D. Prevention and treatment of bedsores / Russian Medical Journal – 2004 – T. 12, No. 12.
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A sick person who has been on bed rest for a long time constantly experiences discomfort - numbness in the limbs, pain, inability to go to the toilet on his own, depression. All this inevitably leads to a deterioration in the patient’s condition, and as a consequence, the development of the disease and the appearance of complications. Bedsores are the result of constant compression of skin and tissue. Most often, bedsores appear in bedridden patients.
The most reliable and effective method treatment - eliminate the cause of necrotic changes. If the patient can move independently, he needs to create a set of physical exercises for daily exercise. If a person is completely immobilized, a guardian must be present at all times and regularly perform hygiene procedures. In the initial stages, it is possible to quickly relieve the symptoms of necrosis and cure bedsores. In later stages, rapid treatment is not possible.

Symptoms

Depending on the degree of damage to the skin and soft tissues, experts distinguish 4 stages of the development of the disease. The appearance of bedsores can be determined by the following symptoms:

• pain and changes in skin color during palpation;
• swelling;
• tingling, burning and itching sensations;
• swelling and violation of the integrity of the skin;
• Sometimes bubbles form and can also be felt in a certain area.

The main symptoms of bedsores at the initial stage are a change in the color of the compressed areas of the skin and the appearance of compactions. Open wounds can not be. It is at this stage that bedsores can be quickly and completely healed.

The next stage is defined as transitional, since weeping wounds and ulcers form in places of compression, the integrity of the skin is damaged, bedsores increase in size and depth (necrosis of the subcutaneous tissue begins). For quick treatment, it is important to maintain cleanliness and order in the location of the bedridden patient, and promptly change and treat wounds. In the treatment of pressure wounds of the second stage, modern medications help well.

It is almost impossible to quickly cure stage 3 and 4 bedsores. This is due to the fact that not only the upper layer of the epidermis is affected, but also the muscles and tendons. Most often, the healing process is slowed down due to constant liquid discharge and deep infection of the wounds. Treatment of necrotic lesions at these stages should be entrusted to a specialist.

Bedsores are tissue changes of a dystrophic and ulcerative-necrotic nature. Bedsores appear on areas of the body that are subject to systematic pressure. They are also formed as a result of various neurotrophic disorders in patients who have been lying down for a long time. In such patients, a prolonged load is created on certain areas of the body, as a result of which a violation of tissue trophism is observed. In most cases, bedsores appear in the area of ​​the coccyx, sacrum, and ischia. Much less often they form in the area of ​​the hip joint, ribs, back of the head, and heels.

Bedsores are also dangerous because, with external minimum skin lesions they can cause intense damage to deeper tissues, often bones, in the structure of which deep cavities and pockets can form. This is often observed with bedsores that have formed in the area of ​​the hip joint and/or sit bones. Long-term bedsores are often the reason for amputation of the joint (hip) and/or lower limb.

Bedsores can be complicated by inflammation of bone tissue in the form of osteomyelitis and periostitis. That is, if the bone is close to the bottom of the wound, then we are talking about contact osteomyelitis. At first, the discharge from this wound is almost transparent; later, when an infection occurs, purulent contents begin to form, sometimes with a putrid, fetid odor.

Causes of bedsores

Almost everyone knows that the tissues of the human body function when they receive the necessary nutrients through the bloodstream. Blood vessels, which permeate all human tissues in millions, appear as elastic tubes that are a kind of “conductor” of blood to all organs and tissues of the human body. The smallest of the blood vessels are called capillaries, which are extremely important for optimal metabolism in the body. The flow of blood through such tubes can be easily slowed down or stopped altogether by squeezing them. In every sitting or lying person, compression of the blood vessels begins to occur, and, as a result, compression of the soft tissues, the cause of which seems to be inadequate blood flow to the tissues. When this condition lasts more than two hours, ischemia begins to develop, and later necrosis of soft tissues. The bedsore begins to develop.

There are endogenous and exogenous bedsores in a patient. The factor of strong long-term compression of soft tissues plays a certain role in the cause of the development of exogenous pressure ulcers.

Internal and external exogenous bedsores are determined. External pressure ulcers often appear in places where there are virtually no muscle fibers between the skin under pressure and the underlying bone. For example, such places include: the back of the head, shoulder blades, femoral condyles, area olecranon, sacrum, etc. Typically, these bedsores are observed in patients after operations or after injuries, who are forced to remain in a certain position for a long time, usually lying down. The main causes of exogenous bedsores include: incorrectly fixed plaster splints or plaster casts, incorrectly fitted prostheses, medical orthopedic devices and corsets, as well as tight bandages, folds of clothing and sheets. Internal exogenous pressure ulcers develop under hard catheters or drainages that remain in the wound cavity or organ for a long time.

Endogenous bedsores appear with intense circulatory disorders and neurotrophic disorders. Endogenous mixed and neurotrophic pressure ulcers are determined. Mixed pressure ulcers are observed in weakened patients who cannot independently change the position of a limb or body. Prolonged immobility leads to ischemia of the skin, impaired microcirculation in the area of ​​bone protrusions and the development of bedsores.

Endogenous neurotrophic pressure ulcers appear in patients with damage to the spinal cord, large nerves, stroke, or brain tumor. Due to disruption of innervation, persistent neurotrophic disorders begin to develop in tissues. For the development of neurotrophic pressure ulcers, the weight of one’s own skin over bone protrusions is sufficient. For example, above the costal arches, above the upper anterior iliac spines.

Risk factors for the development of bedsores in a patient are: poor nutrition and insufficient fluid intake into the body, or exhaustion, diseases of the cardiovascular system, urinary incontinence, injuries and back fractures, contaminated skin, crumbs and small objects under a bedridden patient, folds and seams on clothes.

Stages of bedsores

As mentioned above, bedsores form in those places that are subject to prolonged pressure for a long time and the blood supply in such places is disrupted. Bedsores are classified, as a rule, according to the depth of their damage to soft tissues; so to speak, assess the condition of the affected tissues and their depth.

There are 4 stages of development of bedsores:

— The first stage of bedsores is characterized by tissue compaction in the affected area and its hyperemia, swelling may be observed. At this stage, bedsores are very well treated with antibacterial therapy using wound-healing drugs.

— The second stage of bedsores is characterized by the formation of erosions and ulcers in the affected area. But, at this stage, proper tissue damage has not yet occurred. Only the upper layer of the epidermis is affected. The second stage can also be successfully treated, and with well-chosen and carried out tactics, a stable improvement in the condition of a patient with bedsores is possible.

— The third stage of bedsores is characterized by deeply intense damage to the tissues that are located under the skin. Damage to the subcutaneous layer occurs, which ultimately leads to irreversible necrotic lesions. This stage is extremely difficult to treat.

— The fourth stage is characterized by excessive damage and necrotic changes in soft tissue, as well as impaired circulation in these areas. Such changes can ultimately lead to severe intoxication of the entire body and further blood poisoning (sepsis).

Clinical manifestations of bedsores in a patient appear against the background of a main, often extremely serious disease and depend on the type of pathogenic microflora and the nature of necrosis. In the first stage, moderate local pain and a slight feeling of numbness are determined. In case of spinal cord injury, areas of necrosis can form within a day; in other cases, the transition of bedsores to the second stage of the process is slower.

With the development of bedsores in the form of dry necrosis, the patient’s condition does not change much, because the intoxication of the body is not very pronounced. The mummified lesion ends in a line of demarcation because dry necrosis does not spread.

A different clinical picture can be observed when bedsores appear in the form of wet necrosis. Foul-smelling contents are released from under necrotic tissues; as a result of the intensive proliferation of pathogenic and putrefactive flora, the purulent-necrotic process begins to rapidly spread. The resulting decubital gangrene provokes the development of purulent-resorptive fever and severe intoxication of the body. A rise in body temperature to 40˚C, delirium, depression of consciousness, chills, tachycardia, shallow breathing, decreased blood pressure, enlargement of the spleen and liver, etc. Severe intoxication is combined with proteinuria, pyuria, anemia and progressive dysproteinemia. In the blood there is a significant increase in leukocytes with neutrophilia with a shift to the left, and an increase in ESR.

Bedsores very often lead to complications. The most serious and common of these is sepsis.

Due to the fact that it is not always possible to determine only by appearance what specific stage of development the lesion of the skin and tissue is at, then for correct setting For diagnosis, they resort to methods such as the culture method and tissue biopsy from the pressure sore.

Bedsores treatment

Treatment of bedsores should be carried out based on two main conditions: rapid restoration of optimal blood flow to the damaged area of ​​the body; necessary measures for the rapid healing of wound cavities that have formed as a result of bedsores.

When the color of the skin changes, stop all pressure on this skin area by changing the position of the body; the skin is treated with camphor alcohol; place an inflatable rubber circle under the patient; wash the patient with cold water. With the development of areas of necrosis, local therapy is aimed at drying necrotic tissues and preventing the transition of dry necrosis to wet necrosis. To do this, they resort to using: 1% potassium permanganate solution, 0.5% aqueous-alcoholic solution of Chlorhexidine, 1% brilliant green solution. The area of ​​deep bedsores is covered with a dry antiseptic bandage. At this stage, the use of ointments and wet dressings. After the scab is rejected from the bedsore and its wound cavity is filled with granulations, ointment dressings are used or autodermoplasty is performed according to indications.

For deep bedsores that occur in the form of wet necrosis, the main goal of local therapy is to achieve rapid rejection of necrotic tissue. Proteolytic enzymes are considered the most effective in this regard, in particular immobilized proteases with prolonged action and hydrophilic ointments (Levomekol, Levosin, Dioksikol). It is acceptable to use bandages with hypertonic solution. If necessary, in some cases necrectomy is performed, the use of which significantly reduces the treatment time for bedsores.

For decubital gangrene and other purulent-necrotic complications, surgical treatment is recommended, opening of purulent leaks, phlegmons, etc. with further drainage and therapy in accordance with the method of treating purulent wounds. Apply different methods plastic closure of defects that formed on the skin after excision of necrotic tissue, and the erosive surface of a bedsore. To close the wound, local tissues are used (rotation plasty with a pedicled flap, s-shaped plasty, etc.) or autodermoplasty with a split skin flap. Skin grafting is also used for extensive granulating wounds during the final stage of local therapy. Antibacterial therapy must be carried out taking into account the sensitivity of pathogenic microflora to it.

In addition to local therapy, intensive high-quality treatment of the underlying disease, the use of stimulating and detoxification therapy should be carried out. To achieve this goal, blood transfusion is used; solutions of hemodez, rheopolyglucin, etc.; They use immunostimulants, vitamin therapy, and prescribe high-calorie diets.

Anti-exudative therapy is well achieved using Delaskin powder. Careful care of bedsores and the skin around them is considered very important. Several times a day, it is recommended to use local baths with Delaskin powder, which promotes healing and epithelization of bedsores. During hygienic procedures, wiping must be carried out with great care, avoiding strong friction against the patient’s skin. After hygienic procedures, the wound cavity is left until completely dry. It is also necessary to apply wet-dry compresses with Delaskin. They continue therapy for 5-7 days.

Antibacterial therapy begins a couple of days after the start of the main treatment. The use of Fusicutan cream is recommended. The cream is applied in a thin layer to the area affected by the bedsore 3 times. per day for 7 days.

For good healing of bedsores, the drug Vulnostimulin is used. It begins to be used on the 9th day after the start of the main therapy, 2 times a day in the morning and in the evening. Therapy continues until the bedsore is completely healed.
For deep bedsores, especially when the damaged area is extensive and difficult to heal, tissue transplantation is performed.

The prognosis for exogenous external pressure ulcers is usually favorable, because after eliminating pressure on the tissue and carrying out adequate therapy, a complete cure can be achieved very quickly. Exogenous internal pressure ulcers are considered more severe pressure ulcers for treatment due to the likelihood of damage to the walls of capillary vessels and hollow organs with the possibility of severe complications. With endogenous pressure ulcers, the prognosis is usually unfavorable, because the patient’s condition is significantly complicated by the underlying disease, and the occurrence of a purulent-necrotic process actually reduces the likelihood of a favorable outcome.

Bedsore treatment at home

Despite the fact that the formation of bedsores is a slow process, their treatment and prevention is still necessary. For treatment at home, it is recommended to apply a bandage to the affected area. This method is considered both a way to protect against pathogenic microorganisms and a way to better absorb the ointment into the affected area. A rectangular gauze bandage is applied to the skin and fixed with a hypoallergenic patch along its contour, holding onto healthy areas of the skin. It is better to apply the ointment to the center of the bandage, and not to the center of the bedsore. This therapy can help within two weeks.

Treatment of bedsores at home is recommended to be carried out already in the case of slight hyperemia of the skin and the first manifestations of a bedsore. Treatment is carried out with Tsindol emulsion or zinc ointment. The use of Menalind series cream is also recommended. It also contains zinc oxide. After applying the cream or ointment, the affected area is covered with a bandage. As a rule, the development of education stops.

If there is no skin on the damaged area and deep bedsores up to 2 cm in depth have formed, but there is no green, yellow, purple or red-black plaque and no purulent contents, it can be treated with this remedy. Take a container and wipe it with alcohol. Add part of Dioxidin 1% solution to three parts of Vishnevsky balm. Since these two drugs do not combine well, you need to mix everything thoroughly until it has a homogeneous consistency. For the treatment of bedsores, the prepared composition is applied for 2 days. After this period of time, healing usually begins and a new dressing with a new prepared composition is applied again. If you change the bandage every day, then there may be no effect from the treatment. In some cases, the use of Levomikol ointment is recommended. But according to the latest results of its use, this ointment gives a little noticeable therapeutic effect.

Treatment of bedsores at home is also carried out using medications in the form of Panthenol and Methyluracil ointments, but again, their effect is weaker.

In certain cases, bedsores are recommended to be treated with a thick solution of potassium permanganate. Although potassium permanganate does not help destroy microorganisms, the treated area quickly becomes covered with a crust of black necrotic tissue, under which pathogenic microflora can continue to develop. The purulent process spreads into the deeper layers of soft tissue and the inflammatory process can reach the bone. An unpleasant putrid odor may be heard from the wound cavity. This condition threatens the development of sepsis.

Often, bedsores are treated at home using a variety of methods. traditional methods and means, for example, cabbage leaves. But, as practice shows, in this case it is better not to use this method, since only a surgeon can provide assistance. He excises the necrotic crust from the dead tissue. Afterwards, the wound cavity must be treated with special preparations to remove necrotic tissue.

Treatment of bedsores

Initial care for pressure ulcers should be provided if the patient has redness and swelling at the sites where they appear. As a rule, these are the places where the patient lies for a long time. Later, the skin gradually peels off in thin films, gradually exposing deeper layers. The surface of the skin becomes moist, and pink fluid may be released.

If the pathological process is not stopped in time and its treatment is not started, in such good conditions for the proliferation of pathogenic microflora, numerous ulcers quickly begin to form on the skin, which can be covered with purulent plaque, forming deep bedsores.

As a rule, the patient does not complain of pain syndromes during this process. But this does not mean that the process stands still. Bedsores very often lead to irreversible processes of destruction of skin tissue.

If we do not take into account physiological factors, then the surface on which the patient lies plays a characteristic role in the rapid formation of a bedsore. For example, large folds in a sheet or a lumpy mattress can lead to the patient’s skin developing this disease much faster.

Constant treatment and care of bedsores can significantly speed up the recovery of patients.

The patient's bed should be as comfortable as possible for him. An exception may be the indication for a hard surface, for example, after a spinal fracture.

The bed linen of a bedridden patient should be smooth, dry and clean. It must be replaced every 2 days in order to prevent the development of pathogenic microorganisms from dirty laundry. The sheet should be well stretched and fixed on the bed, there should be no folds on it, and the hanging edges should be tucked under the mattress.

As necessary, special inflatable pillows or rubber circles are placed under the patient’s pelvic area.

During the day, the patient is periodically turned from one body position to another. When bedsores form, it is unacceptable for the patient to remain in one position for more than two hours.

Care and treatment of bedsores is a manual massage to improve blood circulation in those skin areas of the body that are constantly exposed to pressure.

Mandatory air baths are carried out. The affected skin areas are temporarily left uncovered for ventilation. This plays a special role in the care of bedsores.

Treatment of bedsores involves periodically replacing bandage and gauze dressings with medications. Medicines for treating bedsores can be in the form of ointments, creams and antiseptic solutions.

Ointment for bedsores

When a bedridden patient develops bedsores, the most effective method for treating them seems to be the use of ointments.

The main principles in the treatment of bedsores with ointments are: restoration of normal blood circulation to improve tissue trophism; stimulation and activation of general and local tissue regeneration processes; elimination and prevention of the development of bacterial infection in the wound cavity; elimination of possible pain and uncomfortable subjective sensations in the patient.

Accordingly, medications from different clinical groups, which are used in the form of ointments, can be used to treat bedsores. If absolutely necessary, certain of these same medications can be prescribed to the patient orally, that is, in the form of tablets or injections.

Treatment of bedsores should be carried out according to the stages and phases of the wound process, therefore, a specific complex is used for the treatment of each stage medicines.

During the first stage of the wound process, the so-called inflammation phase, medications are prescribed that help cleanse the wound cavity and inhibit the development of the infectious process. Also, these medications improve tissue trophism in and around the area affected by the bedsore. At this stage of the disease, the drugs Actovegin and Solcoserine can be used to improve blood circulation and accelerate tissue healing. At the beginning of therapy, concentrated 25% gels are used, and after two weeks they switch to using 5% cream. At the end of therapy, use 5% ointment until the end of the healing period. These two drugs are presented in the form of extracts from the blood of cattle, and if other experts dispute the advisability of using these drugs orally or injected, then modern medical practice for the treatment of bedsores considers these drugs to be irreplaceable and important component complex treatment.

Algofin ointment has also proven itself in the treatment of bedsores. It is also an extract from seaweed. Its action is based on its high chlorophyll content. It has a powerful antibacterial effect and activates the restoration of soft tissues.

In addition, ointments containing silver ions - Agrosulfan, Dermazin, Sulfargin - can be used to treat the first stage of bedsores. These medicines having antibacterial effect, significantly reduce the severity of burning and pain, accelerate tissue regeneration. Levomekol and Levosin ointments also have an antibacterial and regenerating effect, but their use for the treatment of bedsores at the first stage of a purulent-inflammatory process is not always advisable. If there is no evidence of microbial contamination of the wound cavity, then the prescription of medications that contain antibacterial substances can lead to the development of microflora resistance to the drugs used.

Vulnuzan ointment can also be used to treat the first stage of bedsores. This drug is good for cleansing the wound and sloughing off necrotic tissue. It also has antimicrobial and anti-inflammatory effects.

At the second stage of the wound process, or at the granulation stage, it is recommended to prescribe medications that have a drying effect. At this stage, ointments are prescribed that contain medicinal substances that stimulate the rejection of purulent masses and necrotic tissues, and also activate regeneration processes.

Betadine ointment, which contains iodine, is considered an effective drug. Due to iodine, the drug has an antimicrobial effect, destroys fungus that can enter the wound and promotes the development of viable granulations.

It is possible to use Methyluracil ointment, which contains provitamins that accelerate tissue regeneration and antimicrobial components. The drug has an immunostimulating effect, forms local immunity and promotes the death of pathogenic infectious agents without the development of resistance of these microorganisms to the treatment.

Thiotriazolin ointment stimulates recovery processes and local immunity. In addition, this drug, like Etonia ointment, has an anesthetic effect, eliminating discomfort in the wound cavity and in the tissues that surround it.

At the third stage of the wound process, or at the stage of epithelization, it is recommended to prescribe medications that accelerate the healing process. These medications include: ointments Bepanten, Curiosin, Mephenate, Alantan Plus. The choice of these medications explains not only the condition of the soft tissue in the area where the pressure sore appears, but also the principle of the development of the wound process. Naturally, together with the use of ointment in the treatment of bedsores, those drugs should be used that can help restore impaired physiological processes in the wound itself.

It should be remembered that due attention requires those wound cavities that are contaminated with a fungal infection, or those bedsores that occur in patients in a medical institution. In this case, it is necessary to use highly effective drugs, to whose antibacterial substances pathogenic pathogens of hospital infections have not yet developed resistance. In exceptional cases, the combined use of several medications is recommended, but with mandatory monitoring of their effect and the form of the wound process.

When treating bedsores, the use of medications that form an airtight film on the wound surface, including brilliant green solution, is strictly prohibited. Inadequate therapy can lead to an increase in the area of ​​bedsores and a deterioration in the patient’s well-being.

Prevention of bedsores

To avoid the formation of bedsores, it is necessary to properly care for them and prevent them.

It is advisable to change bed linen every day. It is recommended to place a rubber circle on bedridden patients, who are especially forced to remain in this state for a long period of time in bed on their back. It is placed in a pillowcase so that the area of ​​the sacrum is above its opening. If redness appears on the affected area of ​​the skin, it is recommended to rub the skin in this area with a dry towel or quartz it. Such preventive procedures help improve local blood circulation in soft tissues.

You can also wash the affected skin with cool water and soap or wipe with an alcohol solution and then dust the skin.

good prophylactic agents When caring for bedsores, disinfectant and antiseptic solutions are used to wipe the skin. Such solutions include: camphor alcohol, which must be heated under running hot water before use; table vinegar and room temperature water are also good for preventing bedsores and disinfecting the affected area, which are used in equal parts and apply 2 tablespoons each. medical alcohol and cologne.

The patient's bedsores are treated according to a specific technique for wiping the skin. One edge of the towel is moistened with an antiseptic solution and lightly wrung out. They should wipe the area of ​​the neck, back, behind the ears, chest area, and armpit area. Attention should also be paid to skin folds under the mammary glands, under which diaper rash may appear in sweating overweight women. After wiping with a damp towel, the skin must be wiped dry in the same order.

There are certain devices for preventing the formation of bedsores. These include: pads that are filled with gel, as a result of which their use distributes pressure over a larger area of ​​the skin; a mattress filled with liquid distributes the patient’s body weight well, but such a mattress is very heavy. You can build it yourself by filling rubber gloves and bags with liquid and placing it under the affected areas of the patient’s body, or under those areas that require close attention: the back of the head, shoulder blades, buttocks, back of the calves, etc.

It is also convenient to use a mattress consisting of certain longitudinal sections to prevent bedsores. Their contents move depending on the direction of pressure applied to them. It is recommended to cover this mattress with one sheet to prevent the therapeutic effect from decreasing. But a cellular mattress, as a rule, consists of uneven and lumpy surfaces. Such raised areas on it, which consist of foam, provide preventive massage. And the indentations on such a mattress help relieve pressure on the patient’s skin. It is very convenient for use at home in wheelchairs, or on a bed.

All prevention of bedsores consists of careful care of the bedridden patient. It is recommended to ventilate both the room and the patient’s skin (air baths), because Bedsores really “love” moist skin areas. Adequate nutrition also contributes to the rapid recovery of the body after an injury or illness. And it should be remembered that their development often begins unnoticed. Therefore, prevention is considered a good preventative measure for the formation of bedsores.