Pressure ulcers also known as bed ulcers or bedsores usually occur as a result of long-lasting or repeated pressure which obstructs the blood flow and oxygen supply leading to deep wound with tissue necrosis.
Bedsores can be localized on:
- sacral bone
- wing of ilium
- heals and calf bone
Internal factors predisposing to bedsores:
- sensory disturbances and neurlogical disorders (stoke, akinesia, paralyses, limb paralysis and/or immobility)
- nutritional disorders (protein-energy undernutrition, avitaminosis, overweight/underweight, parenteral nutrition )
- circulatory disorders ( anemia, hypovolemia, peripheral artery disease, thrombosis)
- metabolic and mental disorders (diabetes, obesity, anorexia)
- systemic diseases (neoplasms, AIDS, mucoviscidosis)
- elderly age
External factors predisposing to bedsores:
- mechanical impact on the skin (pressure, friction)
- humidity, maceration (water, urine, faeces, wound exudate)
- climate and environment (high/ low ambient temperature)
- treatment methods (no position changing, improper dressings and pressure relief agents, no massage and rehabilitation)
- care standards (negligence, lack of adequate hygiene and care, underuse of appropriate facilities)
Photo gallery of cases:
Patient 2. – A 46-year-old patient was brought out of a coma in the intensive care unit. The treatment of the ensuing bedsore was impossible, neither at surgery ward nor at an outpatient clinic.
The patient came to our clinic to have a bedsore on his left heel healed. Sore foot, swollen heel and fear of amputation added to the patient’s stress.
The wound covered in necrotic eschar.
Necrotic tissue removal. The healing process was enhanced by the type of dressings selected according to the wound stage.
Treatment completion and further wound care:
Wound care and rehabilitation process.
The healing process took about a year.
A 58-year-old patient led a sedentary lifestyle for several years, spending time in a sitting or lying position, playing computer games without leaving the house. It resulted in a bedsore as deep as to reach the sacral bone with a several-centimetre pocket covered in dead tissue. Having neglected his diabetes and adequate diet, the patient was taken to hospital with already high glucose level.
After 3 months of systemic treatment, and glucose level stabilisation the patient was discharged home.
The wound covered in fibrosis with extensive inflammatory exudate and penetrating deeply into the ulcer. The reddening and swelling around the wound resulted from a chronic inflammation.
After fibrosis removal and the application of long-term dressing with silver ions and pressure relief pads, the condition was gradually improved.
The bedsore removal and treatment was prolonged and tiresome as the patient was reluctant to cooperate and to comply with the instructions. The patient found it very hard to overcome his mental resistance and to follow new recommendations.
The condition after 6-month treatment.
The treatment was completed with the wound closure after 1,5 years. The healed skin area is now being strengthened and treated with foot care agents. However, limited activity caused muscle contracture and partial muscular atrophy.