Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn’t occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers.

What are the symptoms of a pressure sore?
There are four stages of pressure sores. Symptoms of each stage follow:

Stage One. A Stage 1 pressure ulcer is an observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.
Stage Two. Partial thickness skin loss always involves epidermis, dermis or both. The ulcer is usually superficial and presents clinically as an abrasion, blister or shallow crater.
Stage Three. Full thickness skin loss involves damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage Four. Full thickness skin loss involves an extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures (e.g., tendon, joint, capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers.

Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed.

However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation.

Where on the body can you get pressure sores?
Pressure sores usually develop over bony parts of the body that don’t have much fat to pad them.

• Pressure sores are most common on the heels and on the hips.
• Other areas at risk for pressure sores include the base of the spine (tail bone), the shoulder blades, the backs and sides of the knees, and the back of the head.

Key points about treatments.

Prevention is better than cure, but there are several things you can do to help pressure sores heal:

• Inspecting your skin for early warning signs of pressure sores.
• To prevent a pressure sore is to change your position regularly.
• Relieving the pressure that caused the sore and treating the sore itself.
• If you are at risk of getting a pressure sore, you should lie on a supporting foam mattress, not a regular hospital mattress.
• Improving nutrition to help the sore heal

Don’t lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you’re lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart. When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours.

When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. You should change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver shift your position help you.

How should the pressure sore be kept clean?

In order to heal, pressure sores must be kept clean and free of dead tissue. Stage 1 sores can be cleaned with mild soap and water. You can clean stage 3 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore.

Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth. These dressings can stay on for several days at a time.

Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days.

Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry.

The dead tissue sticks to the gauze and is removed when the gauze is pulled off. For more severe pressure sores, dead tissue must be removed surgically.

Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed to help reduce pain.

Why is good nutrition important for healing sores?

Good nutrition is important because it helps your body heal the sore. If you don’t get enough calories, protein and other nutrients (especially vitamin C and zinc, which can help heal wounds like pressure sores), your body won’t be able to heal, no matter how well you care for the pressure sore. Your doctor, nurse or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently.

Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:

• Thick yellow or green pus
• A bad smell from the sore
• Redness or warmth around the sore
• Swelling around the sore
• Tenderness around the sore

Signs that the infection may have spread include the following:

• Fever
• Chills
• Mental confusion or difficulty concentrating
• Rapid heartbeat
• Weakness

How are infected pressure sores treated?

The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).

As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.

How can pressure sores be prevented?

The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously.
It’s also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn’t get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.
If you smoke, you should quit. People who smoke are more likely to develop pressure sores.

Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help.

Why should an air mattress be used as an aid for pressure ulcers ?

The purpose of a decompression mattress is to distribute the body weight evenly on the air mattress by adjusting the firmness and softness of the air tubes inside the mattress through controlled expansion and the air-intake by the compressor. Parts of the body face zero pressure at times to allow blood flow through the pressed tissues and capillaries in order to exchange oxygen and nutrients. The mattress is an important aid for the prevention of bedsores for those who are bedridden, and can reduce the stress of caretakers.

What are the other relative improvements that the flowing air inside the air mattress can provide ?

• Improves blood flow
• Encourages lymph flow
• Reduces pain caused by edema
• Enhances respiratory function

Who needs an air mattress ?

Patients who are impaired (including spinal cord injury), bedridden for a long time, unconscious, have urinary and fecal incontinence, are diabetic or have fragile skin, or suffer from weakness or malnutrition can use the decompression mattress to prevent and to manage the pressure sore problem.

Stage 1-4 of the pressure ulcer – figure

Stage I

Stage II

Stage III

Stage IV

Alternating Mode

Static Mode

Nursing Mode

Auto Dual Mode