Decubitus means the act of or position of lying down. Decubitus ulcer is a med term for a pressure sore or pressure ulcer, sometimes referred to as a bedsore because this skin condition often arises in those who are bedridden. These sores are deteriorated skin areas caused by pressure.
What causes the skin to become damaged is that pressure applied over a bone for a long period of time cuts off the circulation. Without a fresh blood supply, the surrounding skin tissue dies, forming a decubitus ulcer.
Sustained or repetitive episodes of pressure can cause bedsores to evolve quickly, and then advance into a serious skin sore in no time. Not only are pressure ulcers difficult to heal, they can cause a life threatening skin, muscle or bone infection to develop. Pressure sores usually materialize in areas where bones are close to your skin, frequent sights are tail bone, hips and heels.
Basically, your failure to change positions is the root cause of a bedsore. However, there are some other contributing factors that heighten your risk for a pressure sore, such as:
- friction ~ clothing seams, wrinkled sheets
- malnutrition ~ especially deficient in protein, zinc, vitamin C
- thinness ~ inadequate fat & muscle to help cushion your bones
- smoking ~ nicotine impairs circulation & reduces oxygen concentration in blood
- inability to perceive pain ~ spinal cord injury, paralysis, nerve damage, numbness, neuropathy
- poor circulation type health condition ~ diabetes, atherosclerosis, PVD, PAD, other vascular diseases
- incontinence, excessive sweating ~ skin stays moist, making it more susceptible to a break down
- shearing ~ skin moves in one direction, bone moves in the other as with sliding down from an upright position
Bedsores are divided into four different stages based on their severity. Stage I pressure sores are marked by the symptoms of:
- itchy or painful skin
- persistent red skin area
- skin feels warm & spongy or firm to touch
- dark skin may cast a blue, purple, flaky, ashen appearance
Stage I ulcers typically go away shortly after you relieve the pressure.
Stage II decubitus means the area is painful, some skin is lost and it looks like a blister or abrasion surrounded by red or purple discoloration. Stage III pressure ulcers are deep tissue wounds, with a distinct crater look to them.
Finally, a Stage IV pressure sore is very serious. In this advanced stage, you’ve lost a lot of skin coupled with the potential of damage to your muscle, bone, tendons and joints nearby. Your are highly prone to an infection and serious complications at this stage, specifically:
- sepsis
- cellulitis
- gangrene
- meningitis
- osteomyelitis
- necrotizing fasciitis
- septic, infectious arthritis
- cancer ~ squamous cell carcinoma
These complications are rare, but not aggressively treating or preventing a bedsore definitely increases your chances.
Symptoms of pressures sores that have become infected are:
- yellow or green pus
- bad odor emitting from sore
- sore is red, warm, swollen & tender
Before your lesion reaches Stage IV you must see a health care provider for evaluation and treatment of the ulcer.
Ulcer sore care treatment poses a challenge. These pressure caused open wounds heal slowly and imperfectly. As such, your skin remains permanently vulnerable to another decubitus ulcer forming in the same spot.
The initial care in treating a pressure sore is to avoid the compression that caused it. This may entail changing positions often and using special cushions, pads or mattresses, for instance sheepskin cover, emory foam pad, heel pillow, tailbone donut, low air loss mattress, etc. And always use a material next to your skin that absorbs moisture.
Other treatments used in the care of pressure sores involve:
- debridement ~ removal of damaged tissue
- control incontinence with absorbable pads, medications
- oral antibiotic, topical antibiotic cream for sores infected by bacteria
- ulcers covered with hydrocolloid dressing to retain moisture & encourage skin cell growth
- consuming a healthy diet rich in nutrition improves wound healing ~ especially vitamin C & zinc
- hydrotherapy ~ whirlpool baths aid in healing by keeping skin clean & free of any dead or contaminated tissue
- clean open sore with saline solution to prevent an infectious disease ~ antiseptics are not recommended because slows healing
You could meticulously follow all your health care providers recommendations, yet your decubitus ulcer may eventually need surgical reconstruction treatment.
Some additional care treatments being explored for pressure ulcers are hyperbaric oxygen, electrotherapy and topical human growth factors.
The single most important thing you can do in prevention of bedsores is to move the weight off any pressure points regularly, whether your brain tells you need to or not. And the second most important aspect for preventing a decubitus sore is keeping your skin clean and dry.
Otherwise, if you are in a situation where you’re prone to get pressure ulcers, then other key prevention habits include eating a healthy nutrition, quit smoking if that is your case and exercise regularly to improve circulation.