Consequences of bedsores in bedridden patients. Procedures to restore blood flow in the affected area

Pressure sores are significantly different from dermatitis and eczema, although they are also related to skin ailments. But they develop according to a separate mechanism.

Features of the formation of bedsores:

• Occur on the side that is adjacent to hard surfaces. This is due to poor blood circulation.
• Most quickly appear in very weak patients with disorders in the work of the heart. This usually occurs in patients with a large weight, due to the significant pressure of the mass on the tissue.
• Most often appear on protruding parts of the body, that is, on the buttocks, back, shoulder blades and heels. If the patient is constantly on the stomach, then bedsores are formed in the knees and chest. If the patient is always on his side, then the tissues in the area of ​​the ischial tuberosities are affected.
• Sometimes they appear under hard bandages and plaster. Very rare in the area of ​​​​adherence of the denture to the gum.
• At the very beginning of the disease, even before the appearance of visible lesions, light tingling occurs, which indicate the stagnation of fluid in the tissues.

Causes of bedsores

Causes of bedsores:

1. Overweight. With a large body weight, the weight presses on the tissues, accelerating the formation of bedsores. It has also been found that underweight patients are more likely to suffer from them. This is due to the strong compression of the tissues on the one hand by the bone, and on the other by a hard surface.
2. malnutrition. This is due to a lack of vitamins and fluids in the skin. That is why patients are advised to drink a lot and take vitamins.
3. excessive sweating. Most often, bedsores occur in the summer. This is due to an increase in the amount of salts on the skin, which contributes to their development.
4. Uncontrolled bowel movements. Often the appearance of bedsores contributes to the fact that a person does not go to the toilet.
5. The presence of foreign objects on the bed. Crumbs, buttons, and other debris contribute to the development of bedsores. These small objects dig into the skin, impairing blood circulation in it.
6. Cardiovascular diseases. This is due to poor blood supply. Tissues in contact with a hard surface lack nutrients and fluid precisely because of poor blood circulation.

The main symptoms of bedsores

List of symptoms:

• Redness and pain on palpation. This is an early stage in the development of bedsores. The patient feels burning and tingling in the affected area. Swelling appears.
• Edema, violation of the integrity of the skin. Bubbles form in some places. The area is painted in a bright pink color, when probing, an increase in temperature is felt in this area.
• ulcers. On the surface there is a thin crust, under which the skin heals. The ulcer is not deep, affecting the upper layers of the epidermis.
• deep ulcers. This is the most advanced stage, when the lesion reaches the muscle and bone. Tissues die, necrosis develops.

Varieties and stages of bedsores

Types of bedsores:

1. Surface. Characteristic for the onset of the development of the disease. Reminds the affected area of ​​a burn. The skin is dyed bright red. Sometimes small bubbles appear. After the papules burst, after 7-14 days proper care and processing appears epithelium.
2. Deep. These bedsores are characterized by thick-walled blisters. The bottom of the papule is very deep, at the level of the papillary layer of the skin. Such bedsores heal for a very long time, since healing begins from the edges, and in small areas. After the complete separation of the scab, a young epithelium is visible.
3. Dry and wet necrosis. This is the most last stage development of the disease, characterized by the death of the skin. Initially, a huge bubble is formed, which bursts only after 2 months. Under it is a tissue with red vascular streaks. Healing starts from the edges, but the process of tightening the wound takes a very long time. Such bedsores heal on their own only if the size of the ulcer does not exceed 5 cm. In other situations, surgical intervention is indicated.

Features of the treatment of bedsores

Treatment options for pressure ulcers depend on the stage of the disease and the presence or absence of additional infections. Often, deep formations are combined with a bacterial infection. In this case, healing drugs are not enough, antibiotics must be used.

Treatment of bedsores with folk remedies

Before treating bedsores with folk methods, make sure that there are no allergies!

Folk remedies for the treatment of bedsores:

• Onion. Chop two medium sized onions. Pour 40 ml into a bowl vegetable oil and add the onion. Cover and simmer for 10-18 minutes. Constantly stir the onion, it is necessary that it becomes golden. After that, strain the mixture, you only need oil. Put in a quarter church candle and warm up a bit. It should melt completely. Store the ointment in the refrigerator and lubricate the affected areas with it after hygiene procedures. Apply exclusively to clean and dry skin.
• Starch. Potato starch does an excellent job with minor redness, that is, in the early stages of the disease. It is necessary after washing to sprinkle them on the affected area and wrap it with a film.
• Millet. Purchase unpeeled millet. Pour it into an even layer in a pan and heat a little. Pour the grits into clean linen bags and apply to wounds. It is necessary that the application was on the skin for 3-4 hours.
• Calendula. Thanks to its antibacterial and drying properties, calendula copes well with bedsores. It is necessary to grind a tablespoon of dried flowers into powder and mix with 50 g of petroleum jelly. Keep the paste refrigerated and apply only to clean skin.
• Propolis. Grind 10 g of propolis and pour it into the pan. Put the container in a water bath and melt bee product. Enter 30 g of vegetable oil and sweat on fire for 2-5 minutes. Rub this oil on wounds.

Treatment of bedsores with medicines

Review of medicines for treating the skin with bedsores:

1. Solcoseryl and Actovegin. These drugs are used together to treat moderate pressure ulcers. It is necessary to apply 25% Solcoseryl gel to areas that are squeezed. After its complete absorption, the skin is lubricated with Actovegin. Treatment continues for 2 weeks.
2. Dermazin. This is an ointment for bedsores with silver ions, which disinfect the surface and prevent the growth of pathogenic microflora. The product is perfectly applied and completely absorbed without leaving a sticky layer.
3. Tsindol. This is an ointment containing zinc. The medicine dries the skin in the area of ​​bedsores and promotes their healing. The drug is applied once a day until complete recovery. Effective medicine for initial stages diseases.
4. Stellanin. This drug is available in the form of an ointment. Contains diethylbenzimidazolium triiodide, which perfectly disinfects and helps to restore the affected skin. The drug is quite effective and treats bedsores, characterized by the presence of trophic ulcers.
5. Betadine. For the treatment of bedsores, an ointment is used that contains iodine and polymer compounds. The composition of the product does not contain alcohol, thanks to which the surface does not burn and there is no irritation. In addition, Betadine disinfects the surface and removes dead cells.
6. Bepanthen. It is advisable to use the tool together with antibacterial drugs or antiseptics. Bepanten has regenerative properties and helps to restore damaged tissues. Appointed at deep bedsores.
7. Iruxol. This is an ointment that promotes rapid granulation, that is, the maturation of the bedsore and the rejection of affected tissues. Accordingly, a young epithelium appears in a short time, which will speed up recovery.
8. Levomekol. A drug double action. The composition of the ointment contains an antibiotic and a substance that accelerates the epithelization of tissues. Thanks to this, with the help of the remedy, deep bedsores, which are characterized by the appearance of trophic ulcers, can be treated.
9. Hydrogel Intrasite. This is a drug that comes in the form of a gel. It must be applied to very deep bedsores. The substance helps to separate and remove exudate, so that wounds heal faster.

Rules for caring for bedridden patients

Prevention of bedsores:

• Special mattress. This is an anti-decubitus mattress, which can be cellular or balloon. In fact, this is a product in the cells of which the air pressure is constantly changing. That is, some areas are filled with air, and some, on the contrary, are blown away. The surface is constantly in motion, which contributes to a constant change in body position and pressure changes.
• Changing the position of the patient. It is necessary to change the position of the patient every 2-3 hours. This must be done very carefully so as not to stretch or injure the skin.
• Use of pillows and pads. To reduce pressure on some areas, it is recommended to use special foam pads or pads.
• Change of bed linen once a day. It is necessary to change the sheets once a day and make sure that there are no rough seams and folds on the surface.
• Regular hygiene. The body of the patient should be washed daily warm water using toilet soap. It is recommended to use a soft sponge, with its help you need to carry out a light massage that improves blood circulation.
• The use of potassium permanganate and camphor alcohol . These solutions should be lubricated three times a day for areas that are most susceptible to compression. When rubbing alcohol, do a light massage.
• Skin hydration. If the patient's skin is very dry, apply a moisturizer. Physiogel, Lipikar can be considered the most suitable. These creams and lotions form a thin film that prevents moisture from evaporating.

Complications of bedsores

List of complications:

1. Sepsis. This is a blood infection that occurs due to the spread of bacteria from bedsores into the blood. The body cannot cope with the infection, which can lead to death.
2. Phlegmon. This is suppuration of the bedsore, which occurs due to infection of the tissues by bacteria. Most often it is staphylococcus aureus. The disease spreads not only to the superficial areas of the skin, but also to its deep layers.
3. Purulent arthritis. This is inflammation of the joint, which occurs when tissues are damaged by coccal flora. Suppuration occurs in the joint.
4. Arosive bleeding. Appears with deep bedsores. With this ailment, capillaries are destroyed, which leads to severe bleeding.
5. Skin cancer. Non-healing wounds often degenerate into malignant neoplasms.

If subjected to pressure side surface, then bedsores occur on the shoulders, elbows, lateral surfaces of the thighs and pelvis.

Factors affecting the formation of bedsores

Bedsores are a very dangerous complication in seriously ill patient, which worsens the treatment of the underlying disease and requires separate long-term treatment, especially in the last stages.

Phlegmon

Acute inflammation of the cell space is accompanied, treatment is difficult due to the fuzzy border of the inflammatory process. The causative agent is staphylococcus, Escherichia coli. The main symptoms are pain, swelling, redness,. Treatment is carried out by opening the focus and using broad-spectrum antibiotics.

Gangrene

This complication is accompanied by rapid tissue necrosis. On palpation, a specific crunch is heard, the color of the epidermis is predominantly dark, it comes from the wound putrid smell. Intramuscular injections of penicillin give good result, but mainly to avoid damage to adjacent tissues. The affected body part, usually a limb, must be amputated. This complication accompanies, with insufficient or ineffective treatment, bedsores at stage 4 of development.

Sepsis

The fight against this complication is effective only in the early stages. Since it is systemic inflammatory process, which affects the weight of the body as a whole, then further development infection leads to lethal outcome. Detoxification of the body, anti-inflammatory treatment with the use of glucocorticoids is carried out. Septic infection of the body can accompany treatment for 3rd and 4th degrees of bedsores.

Preventive actions

1. Analyze the history and ensure the maximum exclusion of the causes leading to the formation of pressure sores.
2. Use a functional bed for immobile patients, with an anti-decubitus mattress and

Bed sores are one of the most common complications that occur in bedridden patients. What is it?

Bedsores are called changes in body tissues in a certain area (or several), caused by prolonged contact with a hard surface. Such changes are provoked by impaired blood circulation, lymph circulation and innervation.

It is very important to understand what bedsores are, their prevention and treatment.

Development features

It is natural that pressure sores appear on the side of the body on which the person lies, in areas that touch the surface. So, when the patient is on the back, bedsores in bedridden patients most often develop on the buttocks, in the sacrum, coccyx, heels, on the shoulder blades, at the level of the spinous processes of the spine. If a person lies on their stomach, bedsores may appear at such points of contact with the surface: knee area, front surface chest wall, combs ilium. In a semi-sitting position typical place lesions - the area of ​​the ischial tuberosities.

But lesions of areas not listed above are not excluded. For example, bedsores (a photo depicting this pathology can be found in medical directory) sometimes develop on the occipital region and in the folds under the mammary glands. Possible specific location if available plaster bandages in places of their tight fit of the material to the skin, when using oilcloth fabrics, rubber tubes, catheters, prostheses. That is, localization is determined by where exactly there are damaging factors.

The condition of the patient's body is also important. High risk of developing or more rapid development bedsores with general exhaustion, the presence of congestion, which is often observed in heart failure, in patients of advanced age. Young, conscious people, on the other hand, are less likely to develop pressure sores. And if they do appear, they very rarely develop to advanced stages. But at the same time, it should be remembered that due to the gradual development of lesions in these patients, it is sometimes possible to miss the first signs of pathology.

In almost all cases, the development of bedsores occurs according to the same pattern, only the time of each stage is different. The beginning is always stagnation of blood as a result of compression; if left untreated, the affected tissues become necrotic.

What is the danger of bedsores?

The main danger is associated with their complications. Since in most cases bedsores in bedridden patients develop quickly, and quite a short time a large area can suppurate and necrotic, it is often necessary to excise the affected tissues. This sometimes leads to disruption of the blood supply and innervation of nearby areas, which, in turn, leads to disruption of their functioning.

In some cases, the development of bedsores results in a need. In addition, the development of necrotic processes in the periosteum or bone tissue, gas gangrene or sepsis.

It is also important that the processes occurring in the body during the development of bedsores, their treatment require considerable energy costs, therefore, they deplete the patient, thereby aggravating the course of the underlying disease. Festering bedsores are especially dangerous.

Thus, it is very important to understand how to recognize bedsores. The etiology, pathogenesis, prevention, treatment of bedsores of different localization are very similar.

Why do bedsores occur?

The reason for their development is a violation of blood circulation in a certain area of ​​\u200b\u200bthe skin. This can happen in several cases.

Often this phenomenon observed when squeezing blood vessels, especially if the squeezing time exceeds two hours, which happens with a long stay in one position. Tissues that do not receive blood become necrotic, and this is already the development of a bedsore.

A possible cause is microdamage to small vessels in the skin. This can be observed when a wet tissue is pulled out from under the patient, for example, a soiled sheet. Sometimes injuries occur as a result of a person's attempts to independently change position or move around. Therefore, any friction, minor damage to the skin and mucous membranes should be avoided, and if a person wants to turn around or do something, you need to try to help him.

If you know the causes of bedsores, prevention, treatment of such a pathology are carried out more correctly and efficiently.

What increases the risk of pressure ulcers?

In order to understand what pressure ulcers are, what their causes are, what are the prevention and treatment, it is very important to know what affects the risk of their occurrence. There are many such factors. Some of them are related to the characteristics of the patient's condition, others - to the organization of the correct

Of the first group of factors, the most significant are the following features:

• Age- increased risk of development in elderly patients.
• The weight- there is danger here overweight, and inadequate. The more weight, the more pressure on the fulcrum of the body. But insufficient weight often indicates depletion of the body, and this is also a predisposing factor not only for the appearance, but also for the more rapid development of necrotic processes.
• heart disease and vascular system - with pathologies of this type, congestion in the circulatory system develops faster, blood vessels are more easily damaged, any influence that provokes a violation of their integrity is more significant.
• Accompanying illnesses- a special place here is occupied by diseases that lead to a violation of innervation (for example, previous strokes), as well as those in which metabolic processes are disturbed (for example, diabetes).
• Food and drink- insufficient intake of fluids and food is dangerous, it is especially important to monitor the amount of protein in the diet.
• Inability to independently control urination and defecation- this is observed if the patient is unconscious, paralyzed or unable to control his behavior and condition due to dementia.
• Strong sweating- may be as a result of exchange or endocrine disorders, and the result of the presence of fever.
• Features of perception medicines - an unfavorable factor may be the appearance of allergic reactions to drugs used for skin care in places where bedsores develop. Prevention, treatment of bedsores implies the need to take into account all the characteristics of the patient's body.

The second group of factors includes care features. Rare changes of bed and underwear, lack of or improper hygiene procedures, unevenness and excessive hardness of the surface on which the patient lies, the presence of crumbs and small objects in bed increase the likelihood of developing bedsores.

Bedsores: how to recognize them?

If the patient is conscious and sensitive, he can talk about subjective feelings those who care for him. Signs of the beginning of the development of bedsores include complaints of a tingling sensation. It occurs as a result of stagnation of blood and lymph in a place where there is a high probability of the appearance of pathological processes leading to the formation of a bedsore, if not taken necessary measures. As a result of this stagnation, the nerve endings do not receive necessary nutrition but it feels like a tingle. After a few hours, loss of sensitivity is possible, the appearance of a feeling of numbness in areas of the skin to which blood does not flow.

After a while, visible signs appear. In places of contact of the protruding parts of the body with hard surfaces, bluish-red spots appear - venous erythema. They do not have well-defined edges. Their color can be both saturated and barely noticeable.

If such signs were noticed, it is necessary to take immediate measures to prevent the further development of pathological processes in the affected areas. Care must be taken to recognize bedsores. Prevention, treatment of bedsores is the more effective, the earlier the first signs were noticed and actions were taken to eliminate them.

Help with the first signs of pressure sores

For the prevention and treatment of initial stage their development, measures should be taken to even more carefully care for the patient, to ensure that he is able to be in a comfortable and correct position.

Use special mattresses that help those who have bedsores. Prevention and treatment of these formations is the direct goal for which they are made. Such anti-decubitus mattresses are of two types: cellular and balloon. They are equipped with compressors that operate silently and maintain the required hardness of the surface on which the patient lies. For patients who long time are in you can use special pillows filled with air, foam or gel.
If a person is in a supine position, it is desirable that the head of the bed be slightly lowered or at the same level with the body.

Another important factor is the regular change of body position. If there are no contraindications, this should be done at least once every 2 hours. In this case, it is desirable to use specially made pillows. They help to change the position of individual parts of the body relative to the surface on which the person lies. Due to this, for some time between individual areas of the skin and the bed there is space, there is no squeezing blood vessels, reduces the likelihood of development and progression of bedsores. Patients in a wheelchair need a change in body position every hour. The bed on which the patient lies should be remade at least once a day. At the same time, it is important to monitor the condition of bed and underwear - it is dangerous to form wrinkles, get crumbs or other small objects on the linen that can cause irritation and microdamage to the skin.

Hygiene matters a lot skin. Special attention should be given their moisture content. To control this characteristic and prevent excessive hydration, special powders, creams, solutions, sprays, warm (but not hot) baths are used. Specified hygiene procedures should be done at least twice a day. In addition, during urination and defecation, dirt from the skin and linen should be removed as quickly as possible. For this purpose, as well as in order to remove sweat, food debris, wound discharge, use diapers, towels, napkins, diapers, absorbent pads.

It is permissible to stroke areas of the skin where there are signs of congestion, but you can not rub these places, do an intense massage. Such actions can provoke an acceleration of the process.

Pathogenesis

In the pathogenesis of bedsores, four stages of development are distinguished. During stage I, venous erythema develops at the site of skin contact with a foreign surface. The reason for the development of erythema is a violation of the outflow of blood. Outwardly, erythema looks like a bluish-red spot; when pressed, the skin on the affected area turns pale. The temperature in the area of ​​erythema is the same as the rest of the skin or slightly lower. The most common place of development is bony protrusions. The skin remains intact, there are no violations of its integrity.

At the II stage of the development of bedsores, the epithelium becomes thinner, the skin flakes off, bubbles form on it. This is all a consequence of malnutrition of tissues, which occurs due to stagnation of blood. It leads to a violation of innervation. In addition, fluid accumulates in the skin, the cells of the epidermis swell, and eventually rupture and die. Thus, at this stage there are already visible damage to the skin, maceration can be observed on the affected areas.

Stage III decubituses are characterized by the type of wound. If pathogenic microflora enters it, suppuration may develop. It is at this stage in pathological process deep layers of the skin, subcutaneous tissue, muscles are involved, necrotic processes begin. Necrosis and the likelihood of purulent inflammation are a huge threat to the health of the patient.

At stage IV, there is already a significant tissue defect in the form of a cavity, on the walls of which purulent inflammation is visible. The reason for the appearance and increase of the cavity is tissue necrosis.

One person in different parts of the body may have bedsores located on different stages development.

Possible Complications

Most of the complications that occur during the development of bedsores are associated with the ingestion of pathogenic bacteria on the damaged area. Most often it is staphylococcus or streptococcus, but cases of seeding with other pyogenic microorganisms are quite possible.

Most often, suppurative processes in the bedsore develop according to the type erysipelas or phlegmon. In cases of general exhaustion of the body, weak immunity or improper organization hygiene measures, inadequate treatment of bedsores may develop life-threatening complications, such as sepsis or gas gangrene.

Bedsores in patients may begin to suppurate in the second or third stages, when an area of ​​damaged epithelium or an open wound appears, subsequently, further development of purulent processes occurs.

Therefore, if bedsores are present, prevention and treatment are needed not only for them, strict control over the general condition of the body is also important. Alertness should be caused by an increase in body temperature, an increase in weakness, headache, swelling around the bedsore, a change in the color of the skin around it to a grayish, putrid smell from the wound, and other changes.

Typical localization of bedsores

Depending on the position in which the patient lies, where bedsores occur, their prevention and treatment may differ somewhat.
Particular attention should be paid to the options for their possible localization in the position of a person on his back. In this case, bedsores most often occur on the heels, buttocks, coccyx, in the area of ​​​​the shoulder blades.

The occurrence of bedsores on the heels is not uncommon. Since congestion in the legs is often present in older people, as a result of pressure on the heels, such processes are only exacerbated. In addition, usually in these areas of the body, the skin is denser, so it is more difficult to notice the first signs of pathology. For the same reason, with this localization, bedsores (their treatment) require long-term and especially careful attention.

Bedsores on the buttocks are dangerous because this area of ​​the body is close to important organs. The defeat of these organs not only requires careful treatment, but can also greatly affect the future. general condition and the functioning of the body, even shorten life. Therefore, you should apply special efforts to prevent such bedsores. Prevention and treatment (photos depicting appearance such type of bedsores are available in specialized journals) such injuries should be carried out in accordance with all the rules. Otherwise, there is a high probability that the process will lead to undesirable consequences.

Bed sores: treatment and prevention

In addition to knowing what pressure sores are, where they can be, and what they look like, knowledge is needed about how to treat them and how to prevent them. Treatment of bedsores in a patient includes treatment of the skin in hygienic, preventive and proper medicinal purposes. This treatment should be carried out regularly.

It is important to understand the reasons why bedsores appear. Prevention, treatment of bedsores must also be mastered. Hygienic treatment of the skin is carried out to maintain safe level its main properties and characteristics: acidity, humidity, elasticity. To do this, you need to eliminate pollution in time.

Preventive treatment involves actions that improve blood circulation and restore the sensitivity of the skin and underlying tissues. Do not forget that damaged skin is more prone to the occurrence of bedsores and suppurative processes, so it is necessary to prevent its overdrying and the appearance of cracks on it.

Treatment is very important. This already requires special drugs. Now they exist great amount, they are produced in the most different options and forms. A variety of ointments, gels, powders, solutions, sprays are used against bedsores. Each of dosage forms has its own characteristics: contraindications, methods of application. Therefore, it is important to consult an experienced specialist when choosing a treatment.

What is the best cure for bedsores? Feedback from people who have encountered this problem allows us to highlight some of the most common options for solutions that are successfully used in such cases. For external treatment, it is recommended to use a solution of magnesium sulfate (25%), or a hypertonic (10%) solution of sodium chloride with chymotrypsin, and intravenously inject a 0.5% solution of metronidazole. It is undesirable to use potassium permanganate, iodine, brilliant green.

It is very important to ensure that new bedsores do not appear. Prevention, treatment of bedsores usually require a lot of effort, time, and money.

The nutrition of the patient is of great importance. The diet should required quantity vitamins are present minerals, especially zinc and iron, proteins, you need to eat vegetables and fruits. It is recommended to include in the diet dairy products, fish, chicken eggs, meat ( better bird). If it is difficult for a person to eat meat, it can be replaced with broth.

Bedsores are damaged areas of the skin that occur as a result of tissue compression during prolonged contact with a hard surface (bed, wheelchair, tire, etc.). Bedsores appear as a result of bleeding and necrosis of tissues at the site of skin compression.

Causes of bedsores

As you know, the nutrition and saturation of the skin with oxygen occurs due to the presence of blood vessels in it. The smallest of them, called capillaries, penetrate every centimeter of the skin and nourish it. With prolonged squeezing, the vessels are pinched, and blood does not flow. This leads to the fact that certain areas of the skin are bled, and tissue necrosis occurs.

Another reason for the formation of bedsores is the displacement of the upper layers of the skin. This occurs when the patient is being pulled across the bed, or a vessel or wet linen is being pulled under him. All this can lead to a violation of the blood supply, resulting in the formation of bedsores.

Risk Factors for Pressure Sores

People who are most susceptible to pressure sores excess weight or, conversely, malnourished, malnourished and drink little, have a history of diabetes or heart disease, sweat a lot, have brain and spinal cord injuries, suffer from urinary and fecal incontinence. Also considered unfavorable factors are dirty skin, folds and seams on the bed, the presence of crumbs and small objects, as well as allergies to skin care products.

Places of bedsore formation

Areas of the body above bony prominences that are in contact with a hard surface are most susceptible to pressure sores. This is explained practically total absence in these places there is subcutaneous fat, which can reduce pressure on tissues.

If a person long time lies on the back, then bedsores are formed on the sacrum, ischial tubercles, shoulder blades, back of the head, heels and elbows.

When lying on your side, bedsores form on the hips in the region of the greater trochanter, on the knees and ankles.

Prolonged position on the abdomen leads to the formation of necrosis on the pubis and cheekbones.

Degrees of severity of bedsores

Depending on the severity of pressure sores are divided into six stages:

Stage I - reddening of the squeezed areas of the skin occurs;

Stage II - the skin swells, becomes covered with blisters, necrosis (death) of the upper layer of the skin begins;

Stage III - ulcers appear on the skin;

Stage IV - ulcers grow and penetrate into the muscle layer;

Stage V - necrosis and destruction of muscles occurs;

Stage VI - the most severe stage, the ulcer reaches the bone, which can be damaged and infected.

Prevention of bedsores

Prevention of bedsores includes a number of measures aimed at reducing tissue compression and maintaining normal blood circulation in the skin.

For bedridden patients great importance has meticulous care. To reduce tissue compression for bedridden patients, it is necessary to purchase a soft and elastic mattress. On sale there is a special mattress for bedsores, which has a massage effect, improving blood circulation in certain areas of the skin. You can also use a foam mattress if you can't afford a bedsore mattress. It is necessary to change the position of the patient's body as often as possible, and this must be done carefully enough to avoid friction and displacement of soft tissues. The patient's bed should be flat and clean, free of crumbs and foreign objects. Under areas of the body where bedsores usually occur, it is necessary to place rollers or soft foam rubber pads. A special rubber circle can be placed under the sacrum. All these devices (rollers, bedsore mattress) increase the area of ​​​​the body that is in contact with the surface on which the patient is located. This significantly improves blood circulation in the tissues and reduces the risk of bedsores.

Prevention of bedsores also includes the correct and gentle turning of the patient, with minimal risk damage and friction of soft tissues. If you can't do it alone, find someone to help you. Do not pull and pull wet linen and sheets from under the patient, first you need to lift him up. All manipulations for skin care and bedding should be carried out carefully and gently.

To reduce skin irritation, use soft linen (the more washes, the softer the bed) without seams, patches or buttons. To toilet the skin, use soft, low-allergenic cosmetics. Frequent toileting of the genitals and perineum, as urine and feces tend to irritate the skin. Provide optimal temperature conditions in the room, cover and dress the patient depending on the temperature, avoiding overheating. Sweat irritates the skin and increases the risk of ulcers.

Proper skin care is one of the means of preventing bedsores. Don't let your skin get too wet or dry, keep it clean. Use moisturizing and nourishing creams, powders, drying ointments. Do not rub the skin when washing and drying the patient, but blot lightly. Sponges and washcloths should be soft. For urinary incontinence, use diapers or urinals (for men).

Treatment of bedsores

No remedy for bedsores will completely eliminate the problem until the compression of the tissues is eliminated. The main treatment of bedsores should be aimed at restoring blood circulation in damaged tissues. To do this, use all measures to prevent bedsores.

Used to shed dead tissue various means from bedsores. good effect possesses ointment "Iruksol". For more fast healing wounds must be used gauze bandages soaked in Vaseline. You can apply special hydrocolloid dressings if you can buy them (they are quite expensive). There are also special healing remedies for bedsores, in the form various ointments. You can use sea buckthorn oil. With the development of a secondary infection, which often happens when pressure sores occur, antibacterial agents should be used.

Treatment of bedsores, which have a large area and are difficult to heal, is carried out only surgically(tissue transplant).

Video from YouTube on the topic of the article:

Bedsores are dead skin and soft tissues under it, formed during prolonged squeezing or friction. Bedsores usually appear in bedridden patients.

Bedsores vary in severity. The process of formation of a pressure sore begins with a patch on the skin and ends with open wounds in which bones or muscles are visible.

Most often, bedsores form in people with chronic diseases limiting their mobility. According to statistics, bedsores develop in 2.7-29% of people who are hospitalized in the hospital. The risk of skin pressure injuries is especially high in people over 70 years of age, which is associated with skin aging, general deterioration in health and low physical activity.

For some people, bedsores are an inconvenience that requires simple care. For others - serious condition, which can lead to potentially fatal complications such as blood poisoning or gangrene. It is known that the mortality rate of elderly people who come with bedsores to nursing homes reaches 21-88%.

There are a number of techniques to prevent bedsores, namely:

• regular change of body position;
• special equipment to protect vulnerable parts of the body - for example, special mattresses and pillows.

But, unfortunately, even with the highest standards of medical care, it is not always possible to prevent the formation of bedsores in especially vulnerable people.

Signs of bedsores

Most often, bedsores form over the bony protrusions of the body, which are covered with a small layer of soft tissues, including subcutaneous fatty tissue. They form on those parts of the body that are in direct contact with the bed or wheelchair and experience the most pressure.

For example, people who are bedridden most often develop bedsores on the following parts of the body:

• shoulders or shoulder blades;
• elbows;
• back of the head;
• the edges of the ears;
• extensor surface of the knees, heels;
• protrusions of the spine;
• sacrum and coccyx (lower back).

In people in a wheelchair, bedsores most often form on the following parts of the body:

• ischial tubercles (under the buttocks);
• back surface of arms and legs;
• lower back (sacrum region).

Stages of bedsores

The severity of bedsores is assessed on a special scale. The most widely used scale is the European Expert Commission on Pressure Sores (EPUAP). The higher the degree, the more severe the damage to the skin and soft tissues underneath.

I stage- the most superficial decubitus. The affected area of ​​the skin changes color - in people with white skin it becomes red, with swarthy skin it acquires a purple or blue tint. When pressed, the bedsore does not turn pale. The integrity of the skin is not broken, but the affected area may itch or hurt. It may also be hot and uncharacteristically soft or hard to the touch.

II stage- an area of ​​the upper layer of the skin - the epidermis - or a deeper layer - the dermis - is affected, which leads to its damage. The bed sore is similar to open wound or a bubble filled with fluid.

III stage- destruction of all layers of the skin. The subcutaneous tissue also suffers. adipose tissue but the muscles are not damaged. A bedsore looks like a deep hollow wound.

IV stage- the most severe decubitus. Complete destruction of all layers of the skin, subcutaneous tissue, muscles, tendons. Bones and joints may be affected. People with fourth-degree pressure sores are at high risk of death from infectious complications.

Causes of bedsores

Healthy people do not experience bedsores because they are constantly on the move. Even during sound sleep we unconsciously change our position in order to avoid prolonged squeezing of the same parts of the body. During the night, a person tosses and turns in bed up to 20 times.

Bedsores are formed in bedridden or sedentary patients with prolonged pressure on the soft tissues of the body. Due to pressure in the affected area of ​​the skin, blood stops flowing, containing oxygen and nutrients necessary for tissue health. Without a constant blood supply, tissue becomes damaged and eventually dies. The poor blood supply also results in a shortage of white blood cells, the white blood cells that fight infection. After a bedsore has formed, bacteria infect it.

Possible causes of bedsores:

• hard surface pressure - bed or wheelchair;
• pressure from involuntary muscle movements - for example, muscle spasms;
• moisture, which can lead to a violation of the integrity of the upper layer of the skin (epidermis).

In addition, allocate different types mechanical effects that cause damage to the skin:

• surface pressure - pressing the skin against a solid surface by the weight of the body;
• shear and displacement of different layers of skin and soft tissues relative to each other occurs when a person slides down the bed or is lifted from the bed or wheelchair;
• friction, for example, of a mattress or clothing, against the surface of the skin.

The rate of formation of damage depends on the force of compression and the sensitivity of the skin. For example, in people with a predisposition, a bedsore that affects all layers of the skin can form in just one to two hours. However, in some cases, damage becomes noticeable only after a few days. There are various risk factors for pressure sores. They are described below.

Mobility restriction- any reasons that prevent moving the whole body or its individual parts. It can be:

• spinal injury;
• brain damage due to stroke or severe head injury;
• a disease that causes progressive damage to the nerves involved in the movement of the body - such as Alzheimer's disease, multiple sclerosis or Parkinson's disease;
• severe pain that makes it difficult to move the body or its individual parts;
• crack or fracture of a bone;
• recovery after surgery;
• coma;
• a disease that limits the mobility of joints and bones - for example, rheumatoid arthritis.

Improper nutrition- Healthy skin needs nutrients that can only be obtained from food. Reasons for a possible lack of nutrients in the diet:

• anorexia - mental illness in which a person is obsessed with maintaining a low body weight;
• dehydration - lack of fluid in the body;
• dysphagia - difficulty swallowing.

Chronic illness, which disrupts blood circulation or increases the skin's predisposition to injury and damage. For example:

• diabetes mellitus type 1 and 2 - high level blood sugar in this disease can disrupt blood circulation;
• peripheral vascular disease - restriction of blood flow in the legs due to the accumulation of fatty plaques in the vessels;
• heart failure - damage to the heart, in which it is not able to pump enough blood;
• renal failure - a violation of kidney function and the accumulation of dangerous toxins (poisons) in the body;
• chronic obstructive pulmonary disease (COPD) is a group of lung diseases that cause low levels of oxygen in the blood, which can make the skin more vulnerable.

Age over 70 years. There are a number of reasons why aging skin is more vulnerable to pressure sores, including:

• with age, the skin partially loses elasticity (the ability to stretch), which makes it easier to injure;
• decreased blood flow to the skin due to aging;
• layer with age subcutaneous fat, as a rule, decreases, and fat acts as a cushion - shock absorber.

It is important to avoid putting pressure on areas that are prone to pressure ulcers and where they have already formed. Movement and regular position changes help prevent the development of bedsores and relieve pressure on existing ones. Lying patients in bed must be constantly moved. Usually this is done every 2 hours, on the recommendation of a doctor (if there is a high risk of pressure sores) - more often, up to once every 15 minutes.

Anti-decubitus mattresses and pillows

There are various special mattresses and pillows that help relieve pressure on vulnerable parts of the body. Anti-decubitus mattresses and pillows should be chosen together with your doctor. People with a predisposition to pressure ulcers and those who already have pressure ulcers of the first or second stage should purchase a made-to-measure custom order a foam-filled mattress that helps relieve pressure on the body.

People with stage 3 or 4 pressure sores will need a more sophisticated mattress or system. For example, there are mattresses connected to direct current air, which automatically adjusts the pressure as needed.

Dressings and ointments for bedsores

Special dressings help protect bedsores and speed up healing. There are the following types of bandages:

• hydrocolloid - containing a special gel that stimulates the growth of new skin cells in the bedsore, while maintaining the surrounding healthy skin dry;
• alginate - made from algae and containing sodium and calcium, accelerating the healing process.

Can be used to promote healing and prevent further tissue damage. special creams and ointments for bedsores. A decontaminating cream is sometimes applied directly to the bedsore to kill bacteria. Antibiotic tablets are prescribed only for infected bedsores to prevent infection.

Treatment of bedsores - sanitation

In some cases, dead tissue may need to be removed to speed up the healing of a pressure sore. This is called sanitation - cleansing. If there is little dead tissue, the pressure ulcer is treated with special dressings and paste. Large areas of dead tissue must be removed mechanically. Mechanical Methods Pressure ulcer treatments include:

• cleaning and irrigation under pressure - dead tissue is removed by jets of water under pressure;
• ultrasonic cavitation - sanitation of bedsores with the help of high-frequency sound waves;
• laser ablation- dead tissue is removed using high-energy light radiation;
• surgical debridement - cleaning the wound with surgical instruments.

Before treatment, the bedsore and the tissues around it are treated with a local anesthetic so that the debridement does not cause pain and discomfort.

Treatment with larvae

Alternative recovery method. The larvae are ideal for wound debridement, as they feed on dead and infected tissue without touching healthy tissue. They also help fight infection by releasing substances that kill bacteria and promote healing.

During the procedure, the larvae are attached to a bandage that is applied to the wound, and then this area is bandaged. After a few days, the bandage is removed, and the larvae are removed. The idea of ​​maggot treatment seems abhorrent, but some studies have shown that this method of debridement may be more effective than traditional ones. However, this method of treating bedsores is not officially used in Russia.

Surgery to treat pressure sores

Third- or fourth-degree bedsores rarely heal on their own. In this case, an operation is required, which consists in cleaning the wound and closing it by suturing the edges (direct closure) or using tissue taken from a neighboring body area (skin flap plastic).

Surgery to close a pressure sore can be tricky, especially given that people with pressure sores are often already in poor health. The operation is associated with the risk of complications, such as the following:

• wound infection;
• tissue death of the sutured flap;
• bone infection (osteomyelitis);
• bleeding;
• deep vein thrombosis (blockage of a vessel by a blood clot).

Despite the risks, surgery is often necessary to avoid life-threatening complications such as blood poisoning and gangrene (rotting of living tissue).

Why are pressure sores dangerous?

In spite of good care and treatment, stage III and IV bedsores may develop life-threatening complications. They are described below.

Purulent diseases of soft tissues, such as panniculitis - inflammation of the subcutaneous fatty tissue in the area of ​​​​the bedsore and nearby tissues, necrotizing fasciitis - muscle fascia is involved in purulent inflammation, gas gangrene - destruction of soft tissues under the action of bacteria that live without oxygen. All these complications are very dangerous, manifested by an increase in body temperature, severe pain at the site of injury, swelling and redness. With purulent complications, urgent health care: debridement wounds, a course of antibiotics. In severe cases, it may be necessary to amputate limbs.

Blood poisoning (sepsis)- the spread of infection in the blood and throughout the body. This is possible with severe bedsores in people with weak immunity. In the most severe cases, multiple organ infections can lead to sharp drop blood pressure (septic shock) - deadly dangerous complication. Blood poisoning is emergency, requiring immediate treatment in intensive care, where the functions of the body will be maintained with the help of medical devices until the infection can be eliminated.

Joint and bone infection- septic arthritis and osteomyelitis. These complications can cause destruction of joints and bones. Antibiotics are used for treatment. However, in the most severe cases, it may be necessary surgical removal damaged tissues.

Prevention of bedsores

One of the most effective methods of preventing bedsores in bedridden patients is to regularly and frequently change the position of the body. If a bedsore has already appeared, regular movement will help relieve pressure on it and speed up the healing of the wound. Bedridden patients should change the position of the body at least once every 2 hours. Wheelchair-bound people should change position at least once every 15 to 30 minutes.

When a bedsore appears, it is important to try to reduce the pressure on it as much as possible so that the wound heals faster. If a person is not able to move himself, he should be assisted by a relative or a nurse.

For bedridden patients use anti-decubitus mattresses. Under those parts of the body that are most susceptible to compression, foam pillows of various thicknesses from 3 to 10 cm are placed. The bed should be filled with clean cotton linen. It is necessary to ensure that the sheet does not gather in folds, there are no crumbs and other objects in the bed that exert friction and pressure on the body. The underwear of a bedridden patient should be made of natural fabrics, without coarse seams and elastic bands.

It is necessary to strictly monitor skin hygiene, take daily water procedures with liquid soap. During washing, do not rub the skin. If necessary, use diapers or absorbent pads to keep the body dry and clean.

People who are prone to pressure ulcers should check their skin every day for signs of pressure ulcers, such as blemishes. Hard-to-reach parts of the body, such as the buttocks and soles of the feet, can be examined with a mirror. If you find any signs of damage, you should consult a doctor.

Nutrition for bedsores

Healthy balanced diet, including the proper amount of protein and a variety of vitamins and minerals, will help avoid skin lesions and speed up healing. If you have no appetite due to any disease, you should use the following tips:

• Eat small meals throughout the day instead of two or three large meals. You can make a schedule for eating, rather than waiting for the feeling of hunger. Need to consume enough nutrients.
• Before eating, you should not drink a lot of liquid, as this will create a false feeling of fullness.
• If swallowing is difficult, you can try special nutritional drinks or purees and soups.
• Vegetarians need to consume enough vegetable protein. Examples of protein-rich foods include cheese, yogurt, peanut butter, legumes, and nuts.

One of the most effective ways to prevent pressure ulcers for smokers is to stop smoking. Smoking leads to a decrease in oxygen in the blood, and also weakens the immune system, which increases the risk of pressure ulcers.

Which doctor should I contact for pressure sores?

If you or your relative has signs of pressure sores, find a good surgeon. Your doctor will examine your skin and offer you treatment options. You may need to be hospitalized in a surgical hospital. With the help of the NaPopravku service, you can call a surgeon at home.