Pressure Injury

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Pressure Injury

Bedsores (also called pressure ulcers or decubitus ulcers) are injuries of the skin and underlying tissue, resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as heels, ankles, hips and tailbone. 

When a prolonged pressure is applied to soft tissues, the result is an obstruction of the blood flow (it could be partial or complete) to the soft tissue. This condition leads to tissue damage.

Lots of risk factors could be linked with bedsores, and the most important are immobilitydiabetes mellitusperipheral vascular diseasemalnutritioncerebral vascular accidenthypotension, dry skin, low body mass index, urinary and faecal incontinence.

There is a risk of developing pressure sores if the patient has immobility, lack of sensory perception, poor nutrition and hydration or medical conditions affecting blood flow.

Factors that contribute to the pressure injuries are:

  • Pressure: Oxygenation and nutrients are important for the tissues. When the blood flow is too low due to prolonged pressure, the delivery of these two elements is very low. Without these essential nutrients, tissues are damaged, developing a pressure ulcer.
  • Friction: Friction occurs when the skin rubs against clothing or bedding.
  • Shear: Shear occurs when two surfaces move in the opposite direction. 

Pressure injury prevention includes:

  • Nutritional and skincare assessments
  •  Air mattresses or mattress overlays
  • Redistribution of the pressure, changing the position every 2 hours

The most common sites are: sacrumcoccyxheelshipselbowskneesankles, back of shoulders and the back of the cranium. For people who use a wheelchair, pressure sores often occur on skin over the following sites: tailbone or buttocks, shoulder blades and spine, backs of arms and legs 

Classification:

  • Stage I: Intact skin with redness in a localized area usually over a bony prominence. Its colour, thickness and temperature, is usually different compared to adjacent tissue. 
  • Stage II: Partial thickness tissue loss presenting open ulcer with a red-pink wound bed, without slough or open/ruptured serum-filled blister. 
  • Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscles are not exposed. 
  • Stage IV: Full thickness tissue loss with exposed bonetendon or muscle. Slough or eschar may be present on some parts of the wound bed. 
  • Unstageable: Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the wound bed. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels is normally protective and should not be removed.
  • Deep Tissue Pressure Injury: Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discolouration or epidermal separation revealing a dark wound bed or blood-filled blister.

Treatment of pressure injuries includes:

  • Reducing the pressure
  • Healthy diet
  • Controlling the infection
  • Debridement and use of advanced dressings
  • Negative Pressure Wound Therapy (NPWT)
  • Surgery: surgical procedures which include advanced therapy such as platelet-rich plasma (PRP), bioactive tissue matrix allograft composed of dehydrated human amnion/chorion membrane (dHACM), hyaluronic acid ester matrix, naturally-occurring urinary bladder matrix (UBM), a porous matrix of fibres of cross-linked bovine tendon collagen and so on.
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