Pressure Ulcer

What is a pressure ulcer?

A pressure ulcer, also known as pressure sore or bed sore, is a wound caused by prolonged pressure on the skin. Typical locations for pressure sores are are the heels, ankles, hips and over the tailbone. Elderly people and bed- or wheelchair-bound are at risk of developing this condition. Symptoms may include pain in the area, red or purple skin, a break in the skin and, eventually, a wide-based sore which may get bigger over time. The diagnosis is usually easily based on the symptoms and appearance of the area of skin. Treatment involves taking steps to avoid pressure on the area, to keep the wound healthy and, if needed, to close the ulcer. If the wound is small, it may heal well, but large, complicated ulcers can take weeks to months to heal.

Risks

Pressure on the skin is the main cause of pressure sores. A common cause is lying on a certain part of the body for a longer time, although some people develop this condition due to something (such as a device or rough surface) rubbing repeatedly on the the skin. This persistent pressure on one area causes breakdown of the upper layers of skin. If the pressure continues, it can also cause damage to the fat and muscle layers underneath. Normally, the pressure causes discomfort long before the skin becomes damaged, and people turn or move to relieve the discomfort. This condition occurs most commonly in people who are either unaware of pressure causing discomfort, or who are unable to turn themselves to relieve the pressure. Elderly people and those people who are bed-bound are most at risk of this condition. People who have had a spinal cord injury or another neurological condition which affects movement and sensation are also at increased risk. People with conditions which affect blood circulation, such as diabetes or chronic venous insufficiency may also develop pressure sores more easily.

Symptoms

Typical symptoms include red or purple skin in the affected area, skin that is softer and thinner than the surrounding skin, a break in the skin, and an open sore with a wide base. These tend to occur in bony areas, such as over the tailbone, hips ankles and heels, although they can occur in other areas. There may be pain in the affected area, if the affected person does not have a loss of feeling which has contributed to the formation of the sore. If there is an infection, there may be pus in the sore, or it may have an unpleasant smell.

Diagnosis

The diagnosis is usually easily made in a person at risk based on the location and appearance of the wound. If there is any sign of infection occurring in the sore, a swab may be taken in order to identify the bacteria causing the infection.

Treatment

The treatment of pressure ulcer depends on the amount of damage to the skin and underlying tissues. Pressure damage with no broken skin and small ulcers can be healed by taking steps to avoid further pressure on the skin and allowing healing to occur. This involves frequent repositioning to spread pressure evenly over the body and using supportive surfaces, such as special mattresses or cushions. Pain relief may be required. If the wound is severe, surgical cleaning or a skin graft might be needed to repair the wound.

Prevention

People who are bed-bound should take care to turn or be turned frequently. Skin should be protected with special mattresses or cushions to relieve pressure.

Other names for pressure ulcer

  • Pressure sore
  • Bedsores
  • Decubitus ulcers
  • Pressure sores