Pressure ulcers are wounds caused by prolonged immobilization, whether sitting or lying down. They appear on pressure areas like the buttocks or heels.

What is a bedsore?

Definition of a pressure ulcer

A pressure ulcer is a localized area of ​​ischemia (lack of oxygen) causing distress to the skin and subcutaneous tissue, caused by pressure, shearing and / or friction of the skin. It begins with a redness that does not disappear when you press on the skin and develops into a wound that can go to the bone.

The different types of pressure sore

There are four stages in the development of pressure ulcers:

Stage 1: Redness that does not whiten on pressure, on a constant support zone (buttock, heel, etc.). From this stage there may be destruction of the subcutaneous tissues, especially muscles, which are much more sensitive to hypoxia than the skin.

Stage 2: Superficial wound of the skin with abrasion type or simple bubble

Stage 3: Deep wound of the skin affecting the epidermis, dermis and subcutaneous tissues but not affecting the underlying muscles

Stage 4: Wound going to the muscle or even the bone.

The causes of pressure ulcers

Pressure ulcers are linked to constant pressure, even shearing and / or chronic friction of the skin, causing a decrease in vascularization (ischemia) and therefore in oxygenation of the tissues. Muscles are more sensitive to ischemia than skin, so an early pressure ulcer without a skin wound may already have underlying muscle damage.

Who are the people most at risk of developing a pressure sore?

People at risk are people who are immobilized or bedridden, such as hospitalized and bedridden patients, paraplegic patients in wheelchairs, etc.

Diagnosis of pressure ulcers

The diagnosis of pressure ulcers is made during regular observation of the skin by the healthcare team, particularly in relation to the bony prominences, by the discovery of a simple persistent redness of the skin that does not disappear when press it. This is stage 1 of the pressure ulcer. Unfortunately, sometimes the diagnosis is later, especially in people in wheelchairs who have lost all sensitivity (paraplegia …) by the discovery of a wound formed on a “hidden” area: lower back, buttock …

Evolution et complications possible

Even a stage 1 pressure sore can have underlying muscle damage. Pressure ulcers should therefore never be neglected. They are likely to evolve in the following stages rather quickly in the absence of implementation of an adequate treatment. The main complications of pressure ulcers are:

• la pain in people who still have skin sensitivity
• la surinfection of the wound and the underlying noble tissues (osteitis)
• l’lack of healing despite a well-conducted treatment

Symptoms of pressure ulcers

How to recognize the appearance of a pressure sore?

The appearance of a pressure sore is characterized by a simple persistent redness of the skin that does not go away when pressed. This is stage 1 of the pressure ulcer.

Risk factors

The risk factors for pressure ulcers are:

• l’immobilization of a patient in the chair or in bed, causing constant pressure on the skin, even shearing of the skin and / or chronic friction on areas of bone prominence: sacrum, buttock, hips, ankles, elbows, posterior part of the skull in contact with the bed, etc.
• lack of material reducing the risk of pressure ulcers: bed or anti-decubitus chair, cushions limiting prolonged support or foam wedges preventing direct contact of bony prominences between them (knees, heels or ankles, etc.)
• no change of regular position of a patient (if his state of health allows it)
• absence or decrease in pain sensitivity of a patient
• lack of correct positioning and transfer techniques of an immobilized patient, with the aim of limiting friction and shearing of the skin
• zones excessive humidity related to incontinence, sweating or exudate from wounds
• undernutrition or wasting state
• lack of physiotherapy and rehabilitation care with a view to regaining independence and walking, when the patient’s state of health improves

Our doctor’s opinion

Pressure ulcers are one of the most difficult skin wounds to treat because risk factors are often difficult to avoid: constant pressure on the wound due to immobilization, patients in poor general condition and / or undernourished suddenly having cicatrization, patients who have lost their sensitivity to pain (paraplegia, coma, etc.) and are unable to report an aggravation, etc.

In hospitals, we also fear the appearance of a nosocomial infection with multidrug resistant bedsores.

Prevention of pressure ulcers is therefore very important!