Causes of bedsores and their treatment. Development of purulent bedsores similar to erysipelas

Bedsores are ulcers that form when pressure is placed on damaged skin and tissue. They are usually caused by the patient staying in the same position for a long time. When the patient does not move, the blood flow becomes too weak, which leads to the appearance of ulcers. Bedsores usually appear on bony parts of the body where there is no large layer of fat. The most common places are the heels and hips, as well as the base of the spine (tailbone), shoulder blades, back, knees and the back of the head.

Symptoms

There are four stages of bedsores (see picture). Symptoms at each stage include the following:

Stage 1: The affected areas of the skin become red and warm to the touch. The person may experience pain or itching.

Stage 2: Open wounds appear that look like blisters or abrasions. The skin around the wound may change color. The painful sensations intensify.

Stage 3: The wounds become deeper due to increased damage to the tissue under the skin.

Stage 4: The skin and tissue are so damaged that a large wound is created that reaches the muscles, bones, tendons and joints.

Who gets bedsores?

They can appear in people who sit or lie without changing their position long time, for example, if a person is paralyzed, is in wheelchair or spends most of his time in bed. Especially for such patients there is a patronage service "Care", whose specialists will help prevent the formation of bedsores. However, bedsores can occur even in those who are able to move around—some chronic diseases, such as diabetes or hardening of the arteries, lead to poor circulation, which contributes to skin and tissue damage.

To prevent bedsores Use mats, special mattresses and pillows to relieve pressure from damaged areas. When you lie on your side, do not put pressure on your pelvic bones. To do this, place the pillow so that the weight falls on the soft part of the buttocks. Also, use a pillow to isolate your knees and ankles from each other. When lying in bed, change your position every two hours.
When in a chair or wheelchair, sit up straight.

Treatment of bedsores

Treatment for bedsores involves cleaning them and freeing them of dead tissue. In the first and second stages of the lesion, the ulcers can be cleaned with liquid soap and water. For the third and fourth stages, you can use a solution of salt and water for cleansing.

Bedsores should be covered with a damp bandage, which must be changed at least once a day. Nowadays, new types of dressings have become available that include a transparent film and hydrocolloid, a substance in the form of a gel that helps speed up wound healing.

Infected bedsores

Large bedsores can spread a dangerous infection to the rest of the body. Signs of such an infection:

thick yellow or green pus in damaged areas;

unpleasant odor from the wound;

swelling around bedsores;

fever and chills;

confusion and difficulty concentrating;

cardiopalmus.

Treatment of infected bedsores depends on the extent of the infection. If only the skin and subcutaneous tissues are affected, apply to the affected areas special ointment. When bones and deep tissues are infected, treatment is with antibiotics given intravenously or orally. Any treatment can only be started after the approval of the patient's attending physician.

Bedsores are one of the most common complications occurring in bedridden patients. What is it?

Bedsores are changes in body tissue in a specific 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.

Features of development

It is natural for bedsores to appear on the side of the body on which a person lies, in areas touching the surface. Thus, when the patient is positioned on his back, bedsores in bedridden patients most often develop on the buttocks, in the area of ​​the sacrum, coccyx, heels, on the shoulder blades, at the level of the spinous processes of the spine. If a person lies on his stomach, bedsores can appear at the following points of contact with the surface: the knee area, the anterior surface of the chest wall, the iliac crests. In a semi-sitting position, the typical site of injury is the area of ​​the ischial tuberosities.

But damage to areas not listed above is also possible. For example, bedsores (a photo depicting this pathology can be found in medical reference book) sometimes develop on the occipital region and in the folds under the mammary glands. Specific location possible if available plaster casts in places where the material adheres tightly to the skin, when using oilcloth fabrics, rubber tubes, catheters, prostheses. That is, localization is determined by where exactly the damaging factors are.

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 elderly patients. In young, conscious people, on the contrary, bedsores are unlikely to develop. And if they do appear, they very rarely develop to late stages. But at the same time, it should be remembered that due to the gradual development of damage in these patients, the first signs of pathology can sometimes be missed.

In almost all cases, the development of bedsores follows 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 quickly a short time A large area may fester and become necrotic; it is often necessary to excise the affected tissue. 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 becomes necessary. In addition, the development of necrotic processes in the periosteum or bone tissue, gas gangrene or sepsis is possible.

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

Therefore, it is very important to understand how to recognize bedsores. Etiology, pathogenesis, prevention, treatment of bedsores different localization very similar.

Why do bedsores occur?

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

Most often, this phenomenon is observed when blood vessels are compressed, especially if the compression time exceeds two hours, which happens when staying in one position for a long time. Tissues that do not receive blood become necrotic, and this is the development of a bedsore.

A possible cause is microdamage to small vessels in the skin. This can occur when a wet cloth, such as a soiled sheet, is pulled out from under the patient. Sometimes injuries occur as a result of a person’s attempts to independently change position or move. 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 should try to help him.

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

What increases the risk of developing bedsores?

In order to understand what bedsores 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 are related to the organization of proper

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

• Age- increased risk of development in elderly patients.
• Weight- there is a danger here overweight, and insufficient. The greater the weight, the greater the pressure on the body's support points. But being underweight often indicates exhaustion 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.
• Diseases of the heart and vascular system- with pathologies of this type they develop faster congestion in the circulatory system, 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 disruption of innervation (for example, previous strokes), as well as those in which the metabolic processes(for example, diabetes mellitus).
• 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 bowel movements- this is observed if the patient is unconscious, paralyzed, or unable to control his behavior and condition due to dementia.
• Heavy sweating- may be a consequence of exchange or endocrine disorders, and as a result of the presence of fever.
• Peculiarities of perception medicines - an unfavorable factor may be the appearance allergic reactions on preparations used to care for the skin in areas where bedsores develop. Prevention and treatment of bedsores implies the need to take into account all the characteristics of the patient’s body.

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

Bedsores: how to recognize them?

If the patient is conscious and has preserved sensitivity, he can talk about subjective feelings to those who care for him. Signs of the onset of bedsore development 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 pathological processes leading to the formation of bedsores if left untreated. necessary measures. As a result of such stagnation, nerve endings do not receive necessary nutrition, but it feels like a tingling sensation. After a few hours, loss of sensitivity and a feeling of numbness may occur in areas of the skin that do not receive blood.

After some time, visible signs appear. In places where protruding parts of the body come into contact with hard surfaces, bluish-red spots appear - venous erythema. They do not have clearly defined edges. Their color can be either rich or barely noticeable.

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

Help at the first signs of bedsores

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

They use special mattresses that help those who have bedsores. Prevention and treatment of these formations is the direct purpose for which they are made. There are two types of such anti-decubitus mattresses: 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 for a long time You can use special pillows filled with air, foam or gel.
If a person is in a lying position, it is desirable that the head of the bed is slightly lowered or at the same level with the body.

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

Skin hygiene is of great importance. Special attention should be given to their moisture content. To control this characteristic and prevent excessive moisture, special powders, creams, solutions, sprays, and taking a warm (but not hot) bath are used. These hygiene procedures should be carried out at least twice a day. In addition, when urinating and defecating, dirt should be removed from the skin and underwear as quickly as possible. For this purpose, as well as to remove sweat, food debris, and wound discharge, diapers, towels, napkins, nappies, and absorbent pads are used.

It is permissible to stroke areas of the skin where there are signs of congestion, but you cannot rub these areas or do intense massage. Such actions can speed up the process.

Pathogenesis

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

At stage II of the development of bedsores, the epithelium thins, the skin peels off, and blisters form on it. This is all a consequence of tissue malnutrition, which occurs due to blood stagnation. It leads to disruption of innervation. In addition, fluid accumulates in the skin, epidermal cells swell, and eventually rupture and die. Thus, at this stage there are already visible damage to the skin, and maceration may be observed in the affected areas.

Stage III pressure ulcers are characterized by the appearance of the wound. If pathogenic microflora gets into it, suppuration may develop. It is at this stage that the deep layers of the skin, subcutaneous tissue, and muscles are involved in the pathological process, and necrotic processes begin. Necrosis and the possibility of purulent inflammation pose a huge threat to the patient's health.

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

One person has different areas bodies may have bedsores located on different stages development.

Possible complications

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

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

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

Therefore, if bedsores are present, prevention and treatment are not only necessary; strict monitoring of the general condition of the body is also important. Warning should be caused by an increase in body temperature, an increase in weakness, headache, the appearance of swelling around the bedsore, a change in the color of the skin around it to a grayish, putrid odor 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 slightly.
Particular attention should be paid to the options for their possible localization when the person is lying on his back. In this case, bedsores most often occur on the heels, buttocks, tailbone, and shoulder blades.

Bedsores on the heels are common. Since older people often have congestion in their legs, pressure on the heels only worsens such processes. 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, in 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 bodies. Damage to these organs not only requires careful treatment, but can also have a significant impact on the general condition and functioning of the body in the future, and even shorten life. Therefore, special efforts should be made to prevent such bedsores. Prevention and treatment (photos depicting the appearance of this type of bedsores are available in specialized magazines) of such injuries should be carried out according to all the rules. Otherwise, there remains a high probability that the process will lead to undesirable consequences.

Bedsores: treatment and prevention

In addition to knowing what bedsores are, where they can be located and what they look like, knowledge is needed about how to treat them and how to prevent their occurrence. Treatment of bedsores in a patient includes treatment of the skin for hygienic, preventive and therapeutic purposes. This treatment must be carried out regularly.

It is important to understand the reasons for bedsores. Prevention and 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 remove contamination in a timely manner.

Preventive treatment involves actions that improve blood circulation and restore sensitivity of the skin and underlying tissues. Do not forget that damaged skin is more susceptible to bedsores and suppurative processes, so it is necessary to prevent it from drying out and cracks appearing on it.

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

What is the best way to cure bedsores? Feedback from people who have encountered this problem allows us to highlight several of the most common 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 administer a 0.5% solution of metronidazole intravenously. It is not advisable to use potassium permanganate, iodine, or brilliant green.

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

The patient's nutrition is of considerable importance. The diet should contain vitamins in the required quantities, minerals, especially zinc and iron, proteins, it is necessary to consume vegetables and fruits. It is recommended to include dairy products, fish, chicken eggs, meat ( better than a bird). If it is difficult for a person to eat meat, it can be replaced with broth.

A patient who is in a very limited situation physical activity, lies in wait for many accompanying troubles. One of them is the likelihood of bedsores. And this article will tell you about what bedsores look like, what kind of care they require, what are the stages and treatment of bedsores, as well as the prognosis for patients.

Features of the disease

The disease can occur at any age and does not depend on the gender of the patient. Statistics show that more than half of the people who have bedsores are elderly age group. Of course, this is explained by the reduced recovery capabilities of the body during this period.

People who spend long periods of time in static positions have potential danger that they will develop bedsores. The time during which they can form is 2-6 hours.

And such a problem is more likely to overtake a person weakened by the underlying disease. People who also have abnormal weights also fall into the risk zone. Moreover, both increased weight and low weight of the patient have an equally adverse effect on the situation.

Below you will find photos of the initial and subsequent stages of bedsores.

Photos of bedsore stages

Read below about bedsores on the heels, buttocks, tailbone and other places.

Localization of pathology

The areas where pathology forms are determined by protruding parts that appear when lying down.

• If a person spends more time lying on his back, then this may be:
  • coccyx area,
  • buttocks,
  • protruding vertebrae,
  • shoulder blades,
  • elbows,
  • heels.
• When lying on your side for a long time, pressure sores can affect:
  • thigh area,
  • ankles,
  • knees.
• When lying on your stomach, possible affected areas:
  • cheekbones,
  • shoulder,
  • pubis.

This video will tell you what bedsores are and how to prevent them:

Causes

Factors that cause the disease:

• When a patient lies for a long time in one position, at the points where the greatest pressure is created on the skin and tissues underneath, a forced deterioration in blood circulation occurs. As a result, tissues experience oxygen starvation and nutritional deficiency, which can lead to necrotic phenomena.
• People who need to stay in bed as a result of illness have reduced immunity. This fact contributes to the creation of foci with inflammatory processes where there are prerequisites for this.
• Insufficient care bedridden person may be the reason that he will develop bedsores. This is facilitated by lying in one position for more than two hours, incorrect actions at the first signs of bedsores, and insufficient hygiene of the patient.

Symptoms of bedsores

Signs of bedsores depend on the depth of development of the negative process caused by the disease. A sequential description of the symptoms of bedsores, starting with the very first signs and including those that arise during further, if not immediately addressed, deeper processes of tissue damage.

• . The area is located at the point of contact of the body with the bed when lying in one position for a long time. If pressing on the reddened area with a finger does not leave a pale mark, then we can say that a bedsore begins in this place.
• Another sign of a problem will be the fact that redness does not go away immediately when changing positions. At this stage, pain may be felt in the affected area, signaling a problem, or there may be no pain factor.
• The affected area acquires .
• Possible appearance.
• Violation of the integrity of the skin leads to inflammatory phenomena on the skin, the appearance of pus,.
• The process of tissue damage affects deeper layers, right down to the bones.
• Possible infection in wounds, sepsis.

Diagnostics

The presence of bedsores and what stage the process is at is determined by visual examination of the patient. No other diagnostic methods is not intended to indicate a problem.

The exception is cases when bedsores are already in a state of purulent process. To determine possible infection of inflamed areas, the method is used. This method makes it possible, once the presence of infection is confirmed, to identify the causative agent of the infection.

Now let's find out how to treat bedsores, and what are the rules for treating them.

The video below will tell you more about the treatment of bedsores:

Treatment

In the early stages, bedsores are treatable to a much greater extent than when the process has reached severe pathology. Therefore, it is important to notice the violation as early as possible and begin to provide assistance.

In a therapeutic way

A bedridden patient should be turned frequently to prevent any area from becoming stuck. In a place of stable redness, do not massage, but knead the skin around it. At this stage, all care rules are followed so that the skin does not violate its integrity and inflammatory processes do not begin.

Read below about creams, ointments and other remedies for bedsores.

Circle from bedsores

By medication

The following means are used:

• drugs that improve microcirculation in tissues;
• antibiotics,
• creams with a hydrophilic base,
• medicinal oils, including.

A special material will tell you more about this.

Operation

If bedsores already have purulent processes, and dead tissue is observed in the wound, then cleaning of this focus is required. Without cleansing necrotic masses, it is impossible to stop the development of the pathological process. This procedure is performed by a surgeon.

Disease prevention

Measures to prevent bedsores are very important. These problems appear quickly, but correcting the situation is not so easy. Especially if time has passed and the purulent process has already begun.

If the patient is in a situation of limited movement or is completely immobilized, then it is important to perform the following care measures:

• help him at least once every two hours to change his position,
• if the patient experiences involuntary urination, diapers should be used and the perineum should be washed, preventing diaper rash from occurring;
• reddened areas should not be massaged, in order to improve blood circulation in this area, the area around the redness is washed;
• it is necessary to ensure that the surface of the bed is smooth without folds, it is also important that there are no rough seams in the clothes;
• the patient should be given sufficient quantity drinks and vitamin-rich, protein-containing food;
• Hygiene procedures should be carried out in time to cleanse the skin, especially if the patient has increased sweating;
• mattresses against bedsores and special pads should be used for areas where bedsores are expected.

Read below about the risk of developing complications from bedsores, according to doctors’ reviews.

Bedsores are dead areas of skin and soft tissue underneath that form due to prolonged pressure or friction. Bedsores usually appear in bedridden patients.

Bedsores vary in severity. The process of formation of a bedsore begins with a spot 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. The risk of skin damage from pressure is especially high in people over 70 years of age, which is associated with aging skin, general deterioration of 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 admitted to nursing homes with bedsores 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 particularly vulnerable people.

Signs of bedsores

Most often, bedsores form over bony protrusions of the body, which are covered with a small layer of soft tissue, 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 greatest pressure.

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

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

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

• ischial tuberosities (under the buttocks);
• back of the arms and legs;
• lower back (sacral area).

Stages of bedsores

The severity of bedsores is assessed using a special scale. The most common is the European Expert Panel on Pressure Ulcers (EPUAP) scale. The higher the degree, the more severe the damage to the skin and soft tissue underneath.

Stage I- the most superficial bedsore. The affected area of ​​the skin changes color - in people with white skin it becomes red, in people with dark skin it becomes purple or blue. When pressed, the bedsore does not turn pale. The integrity of the skin is not affected, but the affected area may be itchy or painful. It may also be hot and unusually soft or hard to the touch.

Stage II- an area of ​​the upper layer of skin - the epidermis - or a deeper layer - the dermis - is affected, which leads to its damage. A bedsore looks like an open wound or a fluid-filled blister.

Stage III- destruction of all layers of skin. The subcutaneous tissue is also affected fatty tissue, but the muscles are not damaged. A bedsore looks like a deep, hollow wound.

IV stage- the most severe bedsore. Complete destruction of all layers of skin, subcutaneous tissue, muscles, tendons. Bones and joints may be affected. People with stage 4 pressure ulcers are at high risk of dying from infectious complications.

Causes of bedsores

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

Bedsores form in bedridden or sedentary patients with prolonged pressure on the soft tissues of the body. Due to pressure, the affected area of ​​the skin stops receiving blood containing oxygen and nutrients necessary for tissue health. Without a constant blood supply, tissue becomes damaged and eventually dies. Poor blood supply also results in a lack of leukocytes - white blood cells that fight infection. Once a bedsore has formed, it becomes infected with bacteria.

Possible causes of bedsores:

• pressure from a hard surface - a bed or wheelchair;
• pressure from involuntary muscle movements - e.g. muscle spasms;
• humidity, which can lead to disruption of the integrity of the top layer of skin (epidermis).

In addition, they highlight different types mechanical impacts that cause skin damage:

• surface pressure - pressing the skin with body weight against a hard surface;
• 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 a bed or wheelchair;
• friction, for example, of a mattress or clothing, on the surface of the skin.

The rate of damage formation 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, the damage becomes noticeable only after a few days. There are various risk factors for the formation of pressure ulcers. They are described below.

Limited mobility- any reasons that prevent you from 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 body movement - 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.

Poor nutrition- For healthy skin, you need nutrients that can only be obtained from food. Reasons for possible nutritional deficiencies in the diet:

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

Chronic illness, impairing blood circulation or increasing the skin's susceptibility to injury and damage. For example:

• diabetes mellitus type 1 and 2 - high level Blood sugar levels in this disease can impair 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 unable to pump a sufficient volume of blood;
• renal failure - impaired renal function and accumulation of dangerous toxins (poisons) in the body;
• Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that cause low oxygen levels 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 ulcers, including:

• With age, the skin partially loses its elasticity (ability to stretch), making it more easily injured;
• decreased skin blood flow caused by 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 prone to pressure sores or on areas where they have already formed. Movement and regular changes of position help prevent the development of bedsores and relieve pressure on existing ones. Bedridden patients must be constantly moved. This is usually done once every 2 hours, on the recommendation of a doctor (if there is a high risk of bedsores) - more often, up to once every 15 minutes.

Anti-decubitus mattresses and pillows

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

People with stage three or four bedsores will need a more sophisticated mattress or system. For example, there are mattresses that connect to DC air, which automatically adjusts the pressure as needed.

Dressings and ointments for bedsores

Special dressings help protect bedsores and speed up healing. The following types of dressings exist:

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

To speed up healing and prevent further tissue damage, special creams and ointments for bedsores can be used. A disinfectant cream is sometimes applied directly to the bedsore to kill bacteria. Antibiotic tablets are prescribed only for infected bedsores to prevent the development of infection.

Treatment of bedsores - sanitation

In some cases, dead tissue may need to be removed to speed up the healing of a bedsore. This is called sanitation - cleansing. If there is little dead tissue, the bedsore is treated with special dressings and paste. Large areas of dead tissue must be removed mechanically. Mechanical methods for treating bedsores include:

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

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

Treatment with larvae

Alternative method of sanitation. 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 the area is bandaged. After a few days, the bandage is removed and the larvae are removed. The idea of ​​maggot treatment seems disgusting, but some studies have shown that this method of sanitation may be more effective than traditional methods. However, this method of treating bedsores is not officially used in Russia.

Surgery to treat bedsores

Third- or fourth-degree pressure ulcers rarely heal on their own. In this case, surgery is required, which involves cleaning the wound and closing it by stitching the edges (direct closure) or using tissue taken from an adjacent area of ​​the body (skin flap).

Surgery to close a bedsore can be difficult, especially since people with bedsores are often already in poor health. The operation carries a risk of complications, such as the following:

• infectious lesion wounds;
• tissue death of the sewn flap;
• infectious bone lesion (osteomyelitis);
• bleeding;
• deep vein thrombosis (blockage of a vessel with a blood clot).

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

Why are bedsores dangerous?

Despite good care and treatment, with stage III and IV bedsores, life-threatening complications can develop. 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 influence of bacteria that live without access to oxygen. All these complications are very dangerous and are manifested by increased body temperature, severe pain at the site of injury, swelling and redness. In case of purulent complications, urgent health care: debridement wounds, course of antibiotics. In particularly severe cases, it may be necessary to amputate limbs.

Blood poisoning (sepsis)- spread of infection into the blood and throughout the body. This is possible with severe bedsores in people with weak immunity. In the most severe cases, multiple infectious-toxic damage to organs can lead to sharp fall blood pressure (septic shock) - fatal dangerous complication. Blood poisoning is an emergency condition that requires immediate treatment in intensive care conditions, where body functions will be supported 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, surgical removal of the damaged tissue may be necessary.

Prevention of bedsores

One of the most effective methods prevention of bedsores in bedridden patients - regularly and often change body position. If a bedsore has already appeared, regular movements will help relieve pressure on it and speed up the healing of the wound. Bedridden patients should change their body position at least once every 2 hours. People confined to a wheelchair should change position at least once every 15-30 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 unable to move on his own, he should be helped by a relative or caregiver.

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

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

People who are prone to bedsores should check their skin every day for signs of bedsores, such as spots. Parts of the body that are difficult to reach, such as the buttocks and soles of the feet, can be examined using a mirror. If you notice any signs of damage, you should consult a doctor.

Nutrition for bedsores

Healthy balanced diet, including the right amount of protein and a variety of vitamins and minerals, will help prevent skin damage and speed up healing. If you have a lack of appetite due to any illness, you should use the tips below:

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

One of the most effective methods for preventing bedsores for smokers is to quit smoking. Smoking reduces the oxygen content in the blood and also weakens the immune system, which increases the risk of bedsores.

Which doctor should I contact for bedsores?

If you or a relative are showing signs of bedsores, find a good surgeon. Your doctor will examine your skin and give you treatment options. You may need to be hospitalized in a surgical hospital. Using the NaPravku service, you can call a surgeon at home.

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

Stages of bedsores and reasons contributing to their appearance

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

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

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

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

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

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

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

• Increased pain sensitivity due to surgical or traumatic wounds

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

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

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

• Decreased regenerative functions of the skin epithelium

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

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

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

• Constant exposure to high humidity on the skin

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

• Dirty laundry

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

• Malnutrition, insufficient protein intake, and anemia

Reflect general state the patient to resistance against skin lesions of infectious and non-infectious types. Poor nutrition inhibits the body's immune system against pathogens. In addition, anemia results in poor oxygen carrying capacity of red blood cells. The situation is getting even worse with the development cardiovascular pathologies and hypovolemia.

• Reperfusion

Restoring normal blood flow in the ischemic area, according to many experts, also contributes to the prolongation of necrotic processes. The metabolic products accumulated during the period of venous stagnation spread throughout the area of ​​influence, thereby increasing the toxicity in this area.

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

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

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

Pathophysiological basis of pressure ulcer formation

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

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

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

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

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

• sacrum;
• heels;
• back of the head

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

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

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

Features of the localization of bedsores, symptoms and diagnosis

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

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

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

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

Complete blood count with differentiation can show increased content white blood cells, which makes it possible to judge the possible generalization of the pathological process beyond the bedsore, as well as the development of an invasive infection. An erythrocyte sedimentation rate above 120 mm/h and a leukocyte count of more than 15,000 cells/μl forces a number of additional studies to be performed for osteomyelitis.

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

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

Briefly about the treatment and prevention of bedsores

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

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

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

Absolutely all patients whose movement is limited by a wheelchair, bedridden patients, those suffering from paresis or paralysis of certain parts of the body, as well as diseases that reduce the level of brain activity need additional services. People with the following pathologies require special attention:

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

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

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