Pressure ulcers/pressure sores: symptoms, diagnosis and treatment

If open wounds occur in the skin as a result of bedsores, this is called a pressure ulcer. Bedsores occur in varying degrees and mainly occur in people who exercise little or are paralyzed. The pressure then hinders blood flow. Tissue can then die. Elderly people with thin skin are more likely to develop pressure sores.

Causes

Pressure ulcers can be caused by many causes. Seniors are more vulnerable because the skin is less elastic. Patients who are significantly under or overweight are also at greater risk. This also applies to patients with incontinence, neurological disorders, infection, circulatory disorders and poor diet. External factors may include immobility, incorrect lifting (causes friction), poor hygiene, tight clothing and medication such as beta blockers (against constriction of blood vessels) and barbiturates (sleep medication).

Symptoms

Pressure ulcers have different degrees and are divided into four categories.

Symptoms in category 1

  • Complete skin with red spots, usually near bone protrusions
  • Skin discolours
  • Skin feels warm
  • Skin hardens
  • Edema
  • Pain

These spots are more difficult to notice in people with tanned skin.

Symptoms in category 2

  • Loss of dermis
  • Open wound
  • Wound has red or pink wound base
  • Wound may also look like a red blister

Symptoms in category 3

  • Loss of entire skin layer
  • Bone, tendons and muscles are not visible

Symptoms in category 4

  • Skin and tissue layer have disappeared
  • Bone, tendons and/or muscles are exposed
  • Dying crust

Diagnosis

If there may be pressure sores, the doctor will check where they occur. Other causes must also be ruled out, such as diabetes and cardiovascular disease. The GP will then investigate in which category the pressure ulcer occurs. He does this, among other things, by checking whether there is redness, swelling, tissue death and the size and depth of the wound. The patient’s mobility and the aids and measures that have already been taken to prevent pressure sores are also examined. It must also be checked whether there is an infection.

Therapy

The treatment of a bedsore focuses on keeping the wound moist, healing the infection and removing dying tissue and inflammatory fluid. The treatment depends on the stage of the wound. It is important to keep the wound clean.

Gauze/wound dressing

Gauzes should be replaced regularly. If necessary, they can be soaked with the shower head. Wound edges can be treated with special wound dressings containing zinc oil. Wound care in category 1 consists of waiting. If there is dry skin, indifferent ointment can be used. In category 2 (superficial skin defects and blisters), blisters can be treated with hydrophilic gauzes. Hydrophilic meshes protect the blister roof. If there is a wound, treatment is performed with paraffin gauze, covered with hydrophilic gauze or hydrocolloid dressing. If there is inflammatory fluid, wet gauzes should be changed at least three times a day. Alginates can also be used. Inflammatory fluid must also be removed.

Treatment of necrosis

When dying tissue comes loose, it can be removed with scissors or a scalpel. This happens until the underlying tissue starts to bleed or hurt. Special care must be taken at the heel because blood vessels can be damaged when removing necrosis. Before dying tissue is removed, the necrosis can first be soaked by applying wet gauze three or four times a day.

Treatment of open and smelly wounds

For open wounds and smelly wounds, paraffin gauzes with hydrophilic gauzes can provide a solution. Underneath these gauzes there should be gauzes soaked in hypochlorite. They need to be replaced two to four times a day. The gauzes should be used until the infection has cleared. Your GP can prescribe flucloxacillin for pain and fever. The treatment of the wound must be coordinated with, for example, a nurse. If the open wound does not heal after a few weeks, surgical intervention may be required. Heavy necrosis sometimes needs to be surgically removed to prevent bone damage or blood poisoning. Carbon bandages help to counteract the stench of necrosis.

Prevention

The patient can do a lot themselves to prevent pressure sores. If possible, more exercise can offer a solution, as can good sitting and lying posture, good body hygiene and wearing clothing that is not too tight. Aids can also help to prevent pressure ulcers. There are mattresses to reduce pressure on the patient. The pressure value is then better distributed in places where a bedsore occurs. A seat cushion ensures good blood circulation in the skin. The pressure on the skin is also better distributed.