There is a reason why our elders always insisted that we shouldn’t be lazy and must move around as much as possible. Prolonged single-position can cause ulcers in the region of contact, warns Dr Ramesh Kaushal Tripathi.
Bedsores also known as pressure ulcers are synonymous with patients who are bed ridden and have been rendered immobile. But it is important to note that bedsores do not always result from being in bed, as the name would imply.
Some of the most severe bedsores can also result from sitting for a prolonged period of time. Thus, the location of the bedsores can depend upon the position of the patient. They occur due to pressure applied to soft-tissue resulting in completely or partially obstructed blood flow to the soft-tissue.
Pressure ulcers mostly occur due to friction caused on the skin, most common sites being the sacrum, coccyx, heels or the hips. But other sites such as the
elbows, knees, ankles can also be affected.
Dealing with it
While dealing with bedsores it is important to understand that the only way it could be tackled is through repositioning. If detected early, pressure ulcers can be prevented and treated, but it can be very difficult to prevent in critically ill patients, frail elders, wheelchair users (especially where spinal injury is involved) and terminally ill patients.
It is very important to ensure turning and re-positioning the patient in bed or wheelchair in addition to that eating a balanced diet with adequate protein and keeping the skin free from exposure to urine and stool is also imperative.
Risk factors
Some factors can also increase the risk of pressure ulcer development and need to be taken care of. Skin wetness caused by sweating or incontinence, paralysis or neuropathy can aggravate the situation at hand. The healing process may be slowed by the age of the person, medical conditions such as arteriosclerosis, diabetes, infections, smoking, or medications such as anti-inflammatory drugs.
Prevention
There are various measures that could be taken to prevent the occurrence of pressure ulcer. Balanced diet is imperative and it should be kept in mind that malnutrition does not occur.
Not sitting for too long in the same position and repositioning quite often is the foremost preventive measure one can take. For patients who already suffer from bedsores, repositioning at a 30-degree angle on the side would help to a great extent.
Heels should be kept out of the bed and any amount of friction and shearing should be avoided. Waterbeds can be used and any contact with a bony prominence should be avoided. Apart from all the above measures a healthy diet is of utmost importance.
Dressings
The aim of applying a dressing to an ulcer is to provide conditions for the ulcer to allow healing. The first stage is to clean the ulcer and this can be done by gentle washing in salt water. Cleaning debris and dead tissue that accumulates on the surface of the ulcer between dressing changes, can help ulcer healing. Providing a moist wound-healing environment is ideal for pressure ulcers.
A modern dressing such as DuoDerm provides a moist wound-healing environment that promotes wound healing. It also absorbs the exudates and the Gelatin in it holds the dressing as one piece. The patient can also choose to have a shower with this dressing as the outer layer of this dressing has a barrier which will prevent any outside bacteria from entering the wound bed, providing an environment for faster wound healing.
In case of infected wounds, a dressing, that effectively kills bacteria, made of Ionic Silver should be used. The ideal dressing of choice here is a HydroFiber dressing such as AquacelAg/Aquacel which can lock 25 times the volume of exudates and even bacteria (in case of Infection). This dressing becomes a soft cohesive gel ensuring atraumatic removal and no damage to healthy granulation tissue. In case of tunneled /cavity wounds, Aquacel/Aquacel Ag used as a Primary Dressing and DuoDerm used as a secondary dressing will heal the pressure ulcer quickly.
Leg ulcers
A leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin. Vascular leg ulcers are chronic ulcers that fail to heal quickly and generally occur from the pre-tibial region (below the knees) to the toes. 70% - 90% of all leg ulcers result in venous ulcers, which can be very painful. They arise primarily when venous valves that exist to prevent backflow of blood do not function properly, causing the pressure in veins to increase. Failure of the arteries to pump blood results in leg ulcers and their recurrence rate is as high as 65 to 95%.
Risk factors
* High pressure in veins
* Stress
* Hypertension
* Stroke
* Heart attack
Treatment
Vascular leg ulcer can be healed by either applying strong sustained compression with a bandage or a stocking, and by treating the underlying cause of the ulcer. One of the most effective methods of treatment is application of a firm compression bandage or a graduated elastic medical compression stocking to a leg with an ulcer. This will lead to about 70% of ulcers healing within six months. Usage of appropriate dressings could also address the issue faster and more effectively.
(The writer is a vascular specialist)