Bedsore: Encyclopedia - Bedsore

Bedsore

Bedsores, also called pressure sores or pressure ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body, such as bony or cartilaginous areas that are prone to moisture and friction. Decubitus ulcers are pressure ulcers that occur when the patient lies on his or her back for long periods (Wilhelmi and Neumeister, 2005). Examples of areas vulnerable to pressure ulcers include the hips, ankles, heels, elbows, ears, and pressure points on the lower back (near the tail bone, sacrum, or iliac crest). Pressure sores are also caused by prolonged sitting, or certain patterns of sitting behaviour (Bain and Ferguson-Pell, 2002).

Bedsore - Classification

The ulcers are categorized into four stages, subject to size and depth:

• Stage I is the most superficial, with only superficial irritation,
• Stage II is blistering of the skin,
• Stage III involves the full thickness of the skin, and is often complicated by infection,
• Stage IV is the deepest, usually extending into the muscle, tendon or even bone.

With higher stages, healing time is prolonged. While about 75% of stage 2 ulcers heal within 8 weeks, only 62% of stage 4 pressure ulcers ever heal, and only 52% heal within one year (Thomas et al., 2005).

Bedsore - Pathophysiology

Pressure ulcers are caused by inadequate blood supply and resulting reperfusion injury when blood re-enters tissue. A simple example of a mild pressure sore may be experienced by healthy individuals while sitting in the same position for extended periods of time: the dull ache experienced is indicative of impeded blood flow to affected areas. Within hours, this shortage of blood supply, called ischemia, may lead to tissue damage and cell death. The sore will initially start as a red, painful area, which eventually turns purple. Left untreated, the skin may break open and become infected. Moist skin is more sensitive to tissue ischemia and necrosis, and is also more likely to get infected.

Bedsore - Epidemiology

Some studies suggest that 3 to 10 percent of hospitalized patients have pressure sores, with two-thirds occurring to patients over the age of 70. Younger people with neurological impairments also develop pressure sores, because they remain in one position and cannot feel irritation or building pressure. Between five and eight percent of these people have pressure sores during a year.

Bedsore - Prevention

The condition is prevalent in sedentary individuals, such as those living with paralysis or confined to a bed because of illness or impairment.

Nursing homes and hospitals usually set programs to avoid the development of bedsores in bedridden patients (e.g. moving them every two hours, ensuring dry sheets, etc.). Poor nutrition is also a major factor in the formation of pressure sores.

Bedsore - Complications

Pressure sores can trigger other ailments, and cause patients considerable suffering and financial cost (Brem et al., 2004). They are highly likely to become chronic wounds, with only 62% of stage 4 pressure ulcers ever healing, and only 52% healing within one year (Thomas et al., 2005). Some complications include autonomic dysreflexia, bladder distension, osteomyelitis, pyarthroses, sepsis, amyloidosis, anemia, urethral fistula, and very rarely malignant transformation. Sores often recur because patients do not follow recommended treatment or develop seromas, hematomas, infections, or dehiscence. Paralytic patients are the most likely people to have pressure sores recur.

In some cases, complications from pressure sores can be life-threatening. The most common causes of fatality stem from renal failure and amyloidosis.

Bedsore - Famous sufferers

Movie star and stem cell research advocate Christopher Reeve died from complications related to a pressure sore.

See also Gayle Laverne Grinds.

Adapted from the Wikipedia article "Bedsore", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki