Pressure Ulcers

Pressure ulcers or bedsores are open wounds that may occur in immobile lying patients. It is a serious problems as the bedsores are difficult to heal and can cause many complications including severe infections.


Pressure ulcers are usually caused by a combination of more factors. The main reason is a long-lasting pressure affecting the skin. It is usually the pressure occurring between bones and the bed of a lying person. The pressure causes compression of local blood vessels in the affected skin areas and thereby the deterioration of blood and oxygen supply. Skin and deeper tissues are damaged by ischemia and gradually succumb to the necrosis. Lack of hygiene and increased skin moisture (perspiration, urine incontinence, stool incontinence) also contribute to the formation of pressure ulcers. Higher risk of pressure ulcers occurrence is in those patients who are inadequately fed or who suffer from malabsorption of nutrients as the lack of proteins, minerals and vitamins severely reduce the ability of wound healing.


The situation may be worsened by local bacterial infection that is a complication of bedsores further lowering the chance of their successful healing. Given that the body of an obese patient causes a greater compressive force, the obesity is associated with a higher incidence of pressure sores. In the elderly it is the parchment skin that is very sensitive to bedsore occurrence.


The time effect is very important as pressure sore occur when the pressure affects certain body part for a long time. The threat is big especially in patients who are unable to move independently such as unconscious patients, patients with dementia, paralytic patients after spinal injuries, etc.


Bedsores occur usually in sacral area, in elbows and in the area of the shoulder blades. The time needed for a bedsore formation is individual and it depends on many above mentioned factors. The first stage of bedsores can develop within hours.


According to clinical picture and severity, the bedsores are divided into four stages. The first stage still has an intact but irritated skin that is reddish and swollen. If the pressure disappears (by changing the patient’s position), the condition quickly returns to normal. The second stage is typical by blister formation; the skin is swollen and bluish. Shallow wound occurs and the skin cover is disrupted. The third stage is accompanied with formation of a deep wound. The fourth stage is a deep wound extending to the bone. The bone may be affected by infectious inflammation, which further complicates the situation. With disrupted skin layer the wound can be easily infected by bacteria. This can lead to a local infection with possible abscess or gangrene development or to a widespread infection – sepsis.


Bedsores can be easily recognized at first glance. We can make swabs from the ulcers and sent them to a microbiological examination to find out what bacteria colonize the bedsores.


Prevention is in this case much more important than therapy. We must stop the ulcers from occurrence or in the first stage when there is an intact skin cover. The patient must be regularly positioned and well-fed. It is necessary to ensure adequate hygiene and prevent contact between skin and urine or stool. In totally immobile patients, especially when they are unconscious, it is usually impossible to prevent bedsores formation even with the maximal effort.


Developed ulcers are usually treated locally by various healing substances and sterile cover that prevents bacterial infection. The wounds must be kept clean and any bacterial infection must be treated by antibiotics. Deep wounds with necrotic tissue that do not respond to conservative local therapy must be solved by a surgical intervention.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources