Bedsores

Skin and its diagnostic capabilities

The appearance and condition of the skin often reflect the health condition, hormone levels or nutrient deficiencies. For example, in hypothyroidism, the skin becomes dry, wrinkled and specific swellings appear on it. When our body suffers from some allergic reaction, it usually appears on the skin. Skin lesions can also be a symptom of infectious or parasitic diseases. Its condition can also reflects our body’s hydration level is – with insufficient hydration, the skin becomes dry, thin, often peels, lacks elasticity, ages quickly, and becomes wrinkled [1].

Thermoregulation

Thermoregulatory function – our skin is involved in regulating the body’s temperature, due to the underlying blood vessels as well as through the hair and sweat glands. Under cold temperatures, the protective response is to increase blood circulation in the subcutaneous vessels, this is why we get red cheeks or hands from frost. Too much cooling causes the opposite reaction – shrinkage of capillaries and paleness [2].

Chemical barrier

The skin is also an excellent chemical and immune barrier for our body. It contains the sebaceous and sweat glands, which produce an “acid-lipid mantle” on the surface. An acidic reaction close to pH 5.5 protects the skin from microorganisms and alkaline substances. Sweat mixed with sebum forms a thin layer of oil and water emulsion on the surface of the skin, which protects and lubricates, preventing drying and cracking [3].

Threats to the skin

When the human body’s defense mechanisms fail, it may lead to various health consequences. The body then becomes more susceptible to infections, diseases and other harmful factors. The unreliability of defense mechanisms can be caused by genetic, acquired factors (such as chronic stress, malnutrition, disease) or external action (for example radiation, toxins). The direct cause of neglected skin is oxygen deficiency. Inadequate oxygenation of the skin is most often related to our lifestyle. The complexion is adversely affected by alcohol, smoking, poor diet, stress or frequent exposure to UV radiation. Many of these elements can be eliminated with the help of specialists, but sometimes such help is not enough.

Skin bedsores

Lack of movement, chronic pressure and skin friction can all cause pressure ulcers or bedsores. Pressure ulcers in patients in Poland are particularly common in those staying at home or in an assisted living facility (7-23%), in neurological wards (12%), in rehabilitation wards (6%) and in patients with advanced cancer (14-25%) [4]. The most common site of bedsores is around the sacrum, buttocks or heels (patients with paralysis or sensory disorders after trauma). Other common areas for pressure ulcers are elbows, knees and around the ankles. Pressure ulcers can also develop under a plaster dressing.

Grades of bedsores

The essence of the disease process in bedsores is ischemic necrosis of the skin and sometimes of the underlying tissues. Bedsores, depending on the severity of the lesions, can be divided into grades. The higher the grade, the greater the tissue damage and the more difficult the treatment. A number of classifications for the clinical assessment of bedsores are available, including the EPUAP/NPIAP classification, the Torrance system, the Enis and Sarmiento classification, the Oxford Textbook of Palliative Medicine classification and the “colourful” chronic wound classification system [5].

Bedsores – the Torrance system

• grade I – fading redness – reversible (slight finger pressure causes the redness to fade).
• grade II – non-fading redness (epidermal damage) together with superficial swelling, damaged epidermis, blisters, tissue inflammation and swelling, pain.
• grade III – skin damage up to the border of the subcutaneous tissue – the would edge is well demarcated, and the wound bottom is filled with red granulation tissue or yellow masses of decaying (disintegrating) tissue.
• grade IV – the lesion reaches the fascia, and the wound edge is usually well demarcated. The wound bottom may be covered with dry or moist black and/or brown necrosis.
• grade V – advanced necrosis crosses the fascia and reaches bones, joints, ligaments, tendons, muscle tissue. The wound contains decaying tissue masses and black necrosis [6].

Skin with bedsores – diagnosis

The diagnosis of pressure ulcers is established in medical examination. Usually the clinical picture is sufficient. If a bacterial infection is suspected, a swab is taken from the wound. Complications such as osteomyelitis and osteomyelitis may require additional tests.

Bedsores – course of treatment

The treatment of bedsores is often difficult and lengthy, hence it is necessary to follow really strictly the doctor’s instructions on the care and hygiene of the wound and its area. Available today are various ready-made dressings that are dedicated to treat bedsores, each material has its own properties and specific action, making it effective in treating bedsores of a specific degree. Bedsores should be treated by specialists – doing it on one’s own, without knowledge of specialist techniques and dressings is not worth it. If redness won’t fade under pressure in a bed-ridden patient, it is an indication to implement prophylaxis that includes a change of position (every 2 hours or even more often). Massaging these areas when changing positions will also help, as will using anti-bedsore mattresses.

Anti-bedsore mattresses are key in preventing bedsores

Modern anti-bedsore mattresses feature sections that inflate automatically, so that the pressure on the skin of a bed-ridden patient alternates instead of being constant. Anti-bedsore mattresses and pillows are subsidised by the National Health Fund for bed-ridden patients who qualify for such prophylaxis [7]. The prophylaxis involves a range of activities, treatments and the use of equipment to reduce the impact of harmful factors and the risk of developing bedsores. Once a wound has formed, the prophylactic methods must be continued in order to improve healing conditions [8]. An anti-bedsore mattress for hospital beds is an important factor – an item that plays a enormous role in the patient’s recovery, in particular during a prolonged stay in a hospital. The main role of the anti-bedsore mattress for hospital beds, in addition to the patient’s comfort itself, is prevention of pressure ulcers [9].

Anti-bedsores mattress Famed CareSafe

Alternating pressure air mattress vs. hybrid mattress

An example is the FAMED CareSafe alternating pressure air mattress anti-bedsore mattress filled with 17 independent air chambers powered with a pump. An additional foam pad protects the patient should any of the chambers become damaged. The anti-bedsore mattress is designed for use in patients with a very high risk of pressure ulcers. The quiet mode of the pump injecting eight liters of air per minute into the chambers helps peaceful sleep and recovery [10]. The HYPER AIR Hybrid mattress is a high-quality hybrid anti-bedsore mattress used in the treatment of pressure ulcers up to grade 4 (EPUAP). The combination of two types of non-flammable foam with 8 adjustable air chambers ensures maximum patient comfort, prevents pressure ulcers and plays an important role in pain management [11].

Hybrid mattress Hyper Air Hybrid.

Positioners – an effective tool in the prevention of pressure ulcers

Available on the market are also positioners, or speciali medical mats that help to position the patient correctly while lying down or sitting [12]. This is particularly important for people who have to stay in one position for a long time, for example due to illness or rehabilitation. They come in different shapes and are dedicated to different parts of the body. Apart from mats, lightweight half-shafts or side positioners are also available. Such solutions are used especially in operating theaters during long and complex operations. Positioners can also be used at home, such as contoured heel positioners, designed anatomically for better relief of the heel area in the resting position, or relief of the sacral area.

Conclusion

Patients who are immobilised, unconscious, with sensory disorders, often improperly fed, cared for in an unprofessional manner are at risk of developing bedsores. Proper care for a bed-ridden person or in a a person on a wheelchair can not only make their life more comfortable, but also prevent them against painful bedsores. Therefore, it is routinely necessary to take care of the patient’s daily hygiene, as well as to protect the epidermis against excessive pressure and circulation disorders. It is important to remember that bedsores are among the wounds that are hard to heal and cause many health complications, exposing the patient to a lot of additional suffering [13].

Sources:

[1] https://fizjoterapeuty.pl/fizjologia/funkcje-skory.html (dostęp 25.01.2025)

[2] https://fizjoterapeuty.pl/fizjologia/funkcje-skory.html (dostęp 25.01.2025)

[3] https://fizjoterapeuty.pl/fizjologia/funkcje-skory.html (dostęp 25.01.2025)

[4] https://www.mp.pl (dostęp 25.01.2025)

[5] Szewczyk MT, Sopata M, Jawień A i wsp. Zalecenia profilaktyki i leczenia odleżyn. Leczenie Ran 2010; 7: 79106.

[6] https://www.dezynfekcja24.com (dostęp 25.01.2025)

[7] www.pfron.org.pl (dostęp 25.01.2025) 

[8] Włodarczyk, „Profilaktyka i leczenie odleżyn u pacjentów z chorobami układu krwiotwórczego”, w: „Hematologia” 2011, tom 2, nr 4, 349-362.

[9] https://famed.com.pl/produkty/przeciwodlezynowe-materace-lozek-szpitalnych/ (dostęp 25.01.2025)

[10] https://famed.com.pl/produkt/famed-caresafe/ (dostęp 25.01.2025)

[11] https://famed.com.pl/produkt/hyper-air-hybrid/ (dostęp 25.01.2025)

[12] https://medicalonline.pl (dostęp 25.01.2025)

[13] https://www.allecco.pl/artykuly/odlezyny-jak-sobie-z-nimi-radzic.html (dostęp 25.01.2025)