Bedsores:
causes, symptoms and diagnosis

Bedsores are tissue damage that occurs due to constant pressure on an area of skin. Elderly bedridden people are especially at risk. This damage occurs due to too much pressure on one place for too long, leading to poor circulation. People who are bedridden without the use of anti-bedsore systems or those who rely on a wheelchair are especially at risk.

Bedsores can be significant, painful and even life-threatening. Symptoms are divided into four degrees of severity. One of the early symptoms is persistent redness of the skin.

Therapy is often very long. The most important measure is the release of pressure caused by frequent changes of position and storage measures. Wound care depends on the condition and depth of the wound and always belongs to qualified hands. Conservative (without surgical intervention) or surgical procedures are used. Preventive measures and special anti-bedsore systems (see the Topzdrav company website) help avoid bedsores.

What is a bedsore?

A bedsore occurs due to continuous, prolonged pressure on an area of skin. This leads to local damage to the skin or tissue underneath. Preferably these are areas where there are bony protrusions underneath. Due to the pressure, the area can no longer produce normal blood flow. This leads to skin and tissue damage. Those most at risk are bedridden people and people who sit a lot, for example in a wheelchair. Sick, frail or elderly people are particularly common, as are people suffering from paralysis, for example after a stroke.

Causes: how does a bedsore occur?

For example, when we lie on our backs in bed, we place particularly high pressure on certain areas of the skin - usually the back of the head, back, shoulders, elbows and heels. These are areas with prominent bony lobes and low soft tissue coverage. At these pressure points, the blood vessels in the skin are slightly compressed by our own body weight, so blood flow in the skin is reduced. In the short term this is not a problem. As soon as we move, turn on our side, for example, the pressure is distributed differently again. Previously stressed areas of the skin are now relieved of pressure and restored. In general, therefore, the skin tolerates external pressure quite well. It only becomes problematic when it shrinks over a long period of time, such as due to bedridden conditions. The pressure on the skin area lasts too long, and a serious lack of skin nutrition occurs. Within a few hours, the tissue underneath may die.

Preferably, bedsores occur in areas of the skin that are subject to particularly severe stress from prolonged lying or sitting. Additionally, areas where the skin is close to the bone are very vulnerable to pressure sores. Here, the skin, under external pressure, that is, without “damping” by muscles or fatty tissue, is pressed against the bone.

There is also an increased risk of pressure sores in skin folds. Poorly fitted prostheses, too-tight plaster casts, folds in clothing, catheters, infusion tubes or venous dressings in unfavorable cases place local pressure on certain areas of the skin, which leads to bedsores. In addition, shear forces are problematic: for example, the caregiver gradually slides down in his chair, scraping and rubbing the skin on his back on the backrest. This also contributes to bedsores.

Risk factors for pressure ulcers

The danger of lying on a wound is enhanced by certain influences. These include factors that may overall contribute to skin damage:

• Age
• Diabetes
• Weakness due to other diseases
• Impaired blood supply
• Malnutrition and dehydration

Another risk factor is bedsores that have already passed in the medical history. In this case, the affected area of skin has a constantly increased risk of reoccurring pressure ulcers.

Symptoms

What symptoms occur with bedsores depends on the severity of the disease. They are usually classified into four degrees of severity, ranging from milder, more superficial skin changes to severe tissue damage even under the skin. Severe ulcers can permanently destroy muscles, tendons or even bones. If a bedsore is not detected in time, serious complications can occur, such as serious infections involving bone, bone marrow, or dangerous blood poisoning. In very rare cases, with long-term (chronic) wounds, a so-called Marjoline ulcer (squamous cell carcinoma in chronic wounds) can develop. This is a malignant skin cancer. It can take ten to 25 years for a cancerous tumor to appear in a chronic wound.

Diagnosis: how is a bedsore determined?

• Medical history and clinical examination

Early diagnosis of pressure ulcers is important to stop tissue damage so that complications such as infection do not occur. In addition to a medical history that also looks at possible risk factors such as diabetes, the skin is examined and assessed for redness or visible sores. They also look for signs of infection, such as fever.

Bedsores can occur anywhere on the body. However, some parts of the body are especially vulnerable to bedsores in bedridden people. They should be scrutinized regularly by caregivers. These include, for example, the heels, shoulders, back of the head, tailbone and sacrum.

In addition, areas of the skin that are particularly stressed should be examined using prostheses, catheters, infusion tubes, or plaster casts.

• Laboratory chemical / bacteriological / histological studies

Further studies may be worthwhile, starting with grade 2 pressure ulcers and existing signs of infection. This includes taking blood and swabs from the wound to identify the fetus if necessary. If a local area of skin is suspected of cancer, a tissue sample is sent for histological examination.

• Visualization Methods

As a rule, a bedsore is a clinical diagnosis and is established by history and examination. In rare cases, for example, to find out if there is inflammation of the bone, other imaging methods are used. Depending on the question asked, this could be X-rays, MRI or CT scan, or ultrasound.