Definition

A pressure sore is a lesion that develops on the skin and underlying tissues due to unrelieved pressure usually over a bony prominence. The skin and tissues rely on an adequate blood supply for oxygen and nutrients. When tissues are compressed for an extended period from hours to days, blood supply can be cut off, leading to development of a sore.

Pressure Sore (Skin Ulceration)

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Causes

Pressure sores result from lying or sitting in one position for too long a time. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to die.

Several factors contribute to the development of pressure sores including:

• Pressure—Pressure sores can result from the inability to change position or to feel discomfort caused by pressure. People with normal mobility and sensation change position automatically, without thinking.
• Friction—Even friction from pulling someone across bed sheets can damage small blood vessels that supply the skin tissue.
• Poor nutrition
• Moisture—This can come from sweating due to an elevated temperature (fever) or leakage of urine or stool.
• Obesity]]> —Extra weight increases pressure on the skin over the bones and joints.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Immobility, such as being bed- or chair-bound
• Sensory loss
• Poor nutrition
• Incontinence]]> , or leakage of urine or stool
• Advanced age
• Chronic or complex medical problems, such as:
  • ]]>Anemia]]>
  • Infection
  • Poor circulation
  • Neuropathy
  • Dementia
  • Cancer
  • Diabetes
  • ]]>Stroke]]>
  • Spinal cord injury or ]]>paralysis]]>
• Bone fracture
• Swelling or water retention
• Dry skin
• Fever

Symptoms

Symptoms of a pressure ulcer may include:

• Skin tissue that feels firm or boggy
• Local redness, warmth, tenderness, or swelling
• Reddish or purplish skin discoloration, often over a bony area
• Pain or itching of the skin
• Blistering, sores, skin breakdown, or drainage

If the redness remains a half hour after the pressure has been removed, the skin will likely break down. The reddened area may blister and a shallow ulcer may develop. Fluid may drain. The wound can deepen and can extend through fat and muscle to the bone. The area may be painful. The wound can become infected, with redness, swelling, odor, pus, warmth, and fever. If untreated, the infection can progress to gangrene]]> , a blood infection, or an infection of the bone beneath.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the ulcer and note the location, shape, size, depth, stage, and any formation of pockets or cavities. Pressure sores are staged according to the depth and tissues that are involved.

Tests may include:

• Wound culture—taking a sample of material from a sore to be tested for bacteria
• Blood tests—to check for infection and nutritional status
• X-ray]]> or ]]>bone scan]]> —if bone infection is suspected

Treatment

Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure sores. In many cases, a caregiver will provide care for your pressure sores.

Treatment includes:

If you are diagnosed with pressure sores, follow your doctor's instructions .

Prevention

Most pressure ulcers can be prevented. Suggestions include:

• Repositioning
  • Change position in bed at least every 2 hours or, in a wheelchair, at least hourly. If able to move yourself, shift position every 15 minutes.
  • Maintain good body alignment.
  • To prevent sliding, do not elevate the head of the bed greater than 30°. Discuss the bed elevation with your doctor in case this is contraindicated because of risk of difficulty breathing, choking, or aspiration.
  • Find a sitting or lying position that is 30° toward one side or the other, but not squarely on the hip.
  • Place a pillow under calves to keep the heels off the mattress.
  • Place a pillow between the knees.
  • Do not use donut-ring cushions, which can cut off circulation.
• Use a special bed mattress or wheelchair cushion.
• Wear special pads to protect skin that is resting against braces and other devices.
• When moving someone, lift rather than drag.
  • Use assistive devices, such as transfer boards and mechanical lifts.
  • Try placing a sheepskin under a body part to decrease friction.
• Keep the skin clean and dry.
• Do not massage bony areas.
• If incontinent, use a protective cream on skin that may come in contact with urine or stool. Frequently check the patient, and do not let feces or urine remain for extended periods of time
• Check the skin at least daily for signs of pressure problems.
• Keep sheets clean and free of wrinkles
• Maintain good nutrition.