Bedsores are painful injuries to the skin that occur as a result of prolonged, continuous compression of tissue. People who have suffered a serious illness or bone fractures, as a result of which they are in an immobilized state, are predominantly susceptible to the development of bedsores.
Treatment of this complication is quite long and difficult, in advanced cases requiring the help of a qualified specialist. In order to select the most effective remedy for bedsores, the doctor must determine the stage of the pathological process. In addition, treatment of bedsores with folk remedies is allowed. The most effective traditional medicine recipes are time-tested and help achieve the desired results, but before using them you should consult your doctor.
Professional care for bedridden patients and assistance in choosing medications for the treatment of bedsores are offered by highly qualified specialists from the rehabilitation clinic of the Yusupov Hospital.
Reasons for education
Poor circulation, continuous compression of soft tissues and blood vessels leads to the occurrence of stagnation in them and their gradual death (necrosis). This complication occurs especially often (7 out of 10 cases) in older patients. This is caused by the fact that in older people the functioning of the circulatory system deteriorates and the process of tissue self-healing slows down.
Timely implementation of preventive measures and competent treatment can prevent the formation of bedsores. If the medical personnel caring for the patient or family members did not pay attention to the first signs of an approaching problem, then spots on the skin can quickly turn into deep festering wounds, and fistulas can form in their place. The development of severe complications can even lead to the death of the patient.
Bedsores are very difficult to treat, the wounds are cleared slowly, they may re-suppurate, and the formation of new necrotic areas. The fact that the patient is still in a supine position also complicates healing.
But tissue necrosis can occur not only in patients who have been on bed rest for a long time. Any prolonged external compression of tissues, even if the body is in normal condition, can lead to the formation of bedsores. Such a complication can be caused, for example, by an incorrectly applied plaster cast, the patient’s constant presence in a wheelchair, impaired tissue nutrition as a result of severe damage to the spinal cord, and so on.
Most often, bedsores form in areas where there are bony protrusions. There is usually no fat layer there, so there is two-way pressure on the skin: from the outside and the inside. Depending on the position of the body, these may be the surfaces of areas such as
- hips, knees, ankles if the patient is lying on his side;
- cheekbones, iliacus and chest bones, pubis, when the patient is forced to lie on his stomach;
- ischial tuberosity, shoulder blades, elbows, sacrum, back of the head, heels when lying on the back;
- shoulder blades, buttocks, ischial tuberosity, foot bones in people who spend a significant part of the time in a wheelchair.
Among the reasons contributing to the formation of bedsores, several main factors can be identified.
- Overdrying of the skin
- Excessive moisture
- Compression of blood vessels and nerve fibers
- No microvibration
- Decreased muscle mass
- Every 1.5 or 2 hours the patient needs to be turned over and changed position so that external influence (pressure) is applied to other parts of the body. If areas with persistent redness of the skin or maceration develop, you should refrain from placing the patient on this area.
- Try to minimize the force of pressure on the surface of the patient’s body from the outside. Currently, online stores and pharmacies offer a wide selection of devices that provide pressure continuity and reduce its value. These include beds with a built-in special mechanism, anti-bedsore mattresses and pillows filled with water, helium, and air.
- The patient’s diet is also of great importance. First of all, it is necessary to provide the body with “building material” for the formation of new cells. Therefore, products offered to bedridden patients should contain sufficient quantities of not only vitamins and microelements, but mainly protein. An insufficient amount of it can lead to disruption of the immune and regenerative functions of the body.
- Strict adherence to all necessary hygiene procedures, especially after urination, defecation, use of medical diapers, absorbent diapers for bedridden patients, and so on. Several times a day, not only in the morning and evening, wipe the entire body with special products or even just wet wipes to prevent sweat from appearing on the skin.
- Antibacterial soap cannot be used to care for bedridden patients, as it “kills” not only harmful but also beneficial microorganisms for the skin. Alcohol-containing mixtures can cause drying of the skin, so they can only be used for oily skin.
- During manipulations, you should not rub the skin too much; it is best to use soft cotton washcloths, and after performing hygiene procedures, do not wipe the body, but gently blot it or let it dry on its own.
- Massage is also a must. To carry it out, you can use a soft terry mitten, which you can buy or make yourself. The red spots that appear cannot be massaged; you only need to treat the intact skin around it.
As a result, the superficial stratum corneum peels off faster, protecting the skin from external influences.
This problem can occur as a result of excessive sweating, urinary and fecal incontinence. An aggressive environment causes skin irritation, it swells, and friction increases. In addition, high humidity promotes the development of infection.
Blood vessels cannot fully perform their functions: provide tissue cells with nutrients and oxygen. Hypoxia (oxygen deficiency), lack of nutrition, deterioration of metabolism in tissues, as a result of the inability of nerve fibers to perform their functions, lead to a decrease in cell viability and their death.
Compression of the lymphatic vessels negatively affects the functioning of the excretory system. Used and dead cells, along with toxins, processed substances, and waste products, accumulate in the intercellular space and tissues. This, in turn, leads to a decrease in immunity. Microbes and viruses freely penetrate the body, inflammatory processes develop, purulent complications, even blood poisoning.
Even when the body is at rest, muscle cells continue to produce energy due to microvibrations of muscle cells. It promotes more efficient flow of biochemical, metabolic, and physiological processes in the body. The level of microvibrations is maintained at a sufficient height due to physical activity and sports. That is why a sedentary lifestyle leads to a deficiency of this energy, and, as a result, to inhibition of the basic functions of the body.
A decrease or complete absence of muscle load, a sedentary (or completely immobile) lifestyle are the causes of atrophy - a decrease in muscle mass, which in turn leads to a reduction in microvibrations.
Taking into account all of the above factors, the formation of bedsores in bedridden patients and disabled people leading a sedentary lifestyle is a very important problem. The formation of such defects occurs very quickly, and, despite the fact that this complication has been known for a long time, there is not yet a sufficiently effective method of treating and preventing the disease that can quickly restore all functions of the body. The search for new modern therapeutic agents continues, the task still remains relevant.
Causes and risk factors
The main reason for the formation of a sacral bedsore is prolonged compression of the skin between the bone and the bed. People who are bedridden cannot change their position on their own. When the pressure exceeds capillary arterial pressure, then there is a violation of blood circulation in this area, which causes the death of the soft tissues of the gluteal region. The development and rejection of these necrosis leads to the appearance of deep wounds, the bottom of which may be the sacral bone. Bedsores do not form with proper care and the use of special mattresses with a massage effect. The pressure exerted on the skin, soft tissues, muscles and bones depends on the weight of the patient and the characteristics of the surface on which he lies (sits). This load often exceeds the capillary pressure in the skin (~32 mm Hg), which reduces the possibility of blood supply in the integumentary and soft tissues. In patients with reduced sensitivity or immobility, compression does not cause changes in body position. In a short time, if preventive measures are not used, they may develop necrosis of compressed skin and the formation of a purulent-necrotic wound.
Types of bedsores
It may seem strange to most people who have not encountered this problem, but in a sick person, whose body is weakened by the fight against a serious illness, bedsores can appear after just two hours of lying or sitting in one position. The process from minor redness to the appearance of the first signs of necrosis, and then serious wounds, can occur very quickly.
In accordance with the symptoms accompanying formations at various stages of their development and transformation, 4 stages of the disease are distinguished.
- Areas of greatest pressure, which are the most likely areas of damage, are characterized by slight redness, a slight local increase in temperature, and soreness to the touch. At this stage, there is still no structural damage to the skin. If you start treatment at this stage, it will not be difficult to get rid of the first symptoms.
- If treatment is not started, the formation of bedsores will continue. The formation of blisters, loss of integrity and detachment of the skin will begin, the temperature will rise, and tissue swelling will increase. The lesion may reach the layers of subcutaneous tissue.
- This stage is characterized by more serious lesions, up to the first signs of necrosis (death) of areas of the epidermis; muscle and fatty tissue can be observed through areas with dead cells; the wounds are filled with pus.
- The destruction process involves not only skin tissue, but also muscle, bone, fat, and tendons. The wounds are completely filled with purulent contents, the area of necrosis expands, necrotic processes affect all layers. In this situation, therapeutic treatment will no longer bring relief to the patient; surgical intervention is mandatory.
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Disease prevention
As sad as it may be, it is almost impossible to avoid the formation of bedsores in bedridden patients. However, it is quite possible to delay their formation, make the course of the disease easier, and not cause so much inconvenience and pain to a person. To do this, first of all, it is necessary to implement appropriate preventive measures in a timely manner.
It is necessary to take measures to prevent the formation of wounds and ulcers from the first day of the disease. Once the necrotic process has started, it is quite difficult to stop it. When moving to each subsequent stage, the patient will experience more and more suffering and discomfort, and the likelihood of a complete cure will decrease.
Preventive measures taken to prevent the formation of bedsores should be aimed at activating blood circulation, restoring microvibration of tissue cells, and eliminating other factors that provoke the appearance of wounds and ulcers. We must try to return the patient to an active lifestyle as soon as possible. To do this, you can use special medical beds and accessories that allow the patient to at least turn from side to side independently, perform any other movements, actions, even if the function of movement and walking has not yet been restored.
Prevention of bedsores includes the following manipulations.
Modern medical accessories, which should be selected depending on the stage of the disease and the complexity of its course, make caring for bedridden patients as simple as possible, allowing not only to avoid the occurrence of bedsores, but also to provide the patient with comfortable living conditions.
Treatment of bedsores
If a bedridden patient is in an outpatient clinic, then he is cared for by qualified specialists who have the necessary knowledge, practical skills, and appropriate medical equipment. At home, the entire burden falls on the shoulders of family members. At the same time, it is not always possible to perform some manipulations, such as high-quality cleaning of the wound from suppuration, effective gas exchange that ensures drying of the skin surface, and tissue repair. Therefore, if a patient develops bedsores, it is necessary to consult with the attending physician, who will prescribe the appropriate treatment and prescribe procedures.
There are two methods for treating necrotic formations on the skin: conservative and surgical. In the first stages of the development of the disease, it is assumed that the doctor’s instructions are followed, including:
- local treatment with medications, careful hygienic cleaning of the damaged area and adjacent skin with hydrogen peroxide, saline, and so on;
- physical activity with the use of aids for the rehabilitation of disabled and bedridden patients within the limits accessible to the patient;
- the use of antifungal ointments, antibacterial drugs to treat affected areas;
- high-calorie protein diet, with the addition of vitamins (A, C) and microelements (iron, zinc sulfate).
At later stages, when the changes have reached the deep layers of tissue, surgical intervention is required, which involves: drainage of wounds, opening of purulent formations, antiseptic treatment, excision of ulcers, skin transplantation, application of musculocutaneous flaps, and so on. Typically, the hospitalization period is about one and a half months. With timely and correct treatment and careful medical care, in almost 80% of cases the patient’s condition improves significantly, and in 40%, bedsores are completely cured.
Only a doctor can determine the need for surgical intervention during the course of the disease. An untimely or incorrectly performed operation can lead to a deterioration in the patient’s general condition and an increase in the area of the lesion. At the same time, both the patient and his family members should be prepared for the fact that treatment may not lead to an improvement in the condition. As a result of insufficient blood circulation, the transplanted skin may not take root. Fluid may accumulate under the skin. Possible suture dehiscence, bleeding, secondary ulcer formation, skin necrosis and relapse of the disease.
Reviews:
Anna
I would like to express my deep gratitude to Alexander for his professionalism, responsiveness and concern for patients and their relatives, which, unfortunately, is not typical of modern doctors. Alexander promptly came to my mother’s home for a consultation on the treatment of a bedsore, which we tried to cope with for 3 months, involving different doctors. Before this, the healing process was very slow with varying success. Alexander arrived with all the necessary sterile instruments and means for treatment, told and showed how to properly care for a bedsore. He even left the tools and processing equipment so that we had the opportunity, without interrupting the treatment, to order and buy everything we needed. After that, if necessary, he adjusted our treatment. Together with Alexander we dealt with this pain! I will definitely recommend this wonderful doctor! Thank you, Alexander!
Yablonin Boris
Dear Alexander Shadzhievich! I would like to express my sincere gratitude to you for your help. It's hard to overestimate her. From the moment of your first dressing, there was hope that something could be done with such a severe wound. A very important point was the dressing technique, building a wound care system, and the thoroughness and systematic implementation of all subsequent actions. Deep professional knowledge of the processes occurring in the wound, which are noticeable only to a doctor with your experience and knowledge, and most importantly the ability to communicate with a sick person.
It helped me a lot that you systematically and consistently explained to me every day what processes occur in the wound, how they manifest themselves and how they can occur. Rarely do any doctors devote such filming specifically to transferring their knowledge to those who must continue caring for the wound at the stage of further rehabilitation. Without seeing the dressing technique with your own eyes, without trying to do it yourself, using your technique with new dressing materials, it would be impossible to continue caring for the wound yourself. It is not surprising that with such treatment, even I was able to see and adopt your thoroughness, attention to the smallest changes in the wound, consistency and commitment to all the small details of your technique.
Separately, I simply must thank you for the psychological help that you provided to both me and my sick mother, simultaneously with the treatment of the wound itself. This help allowed me to believe in the possibility of recovery and not give up halfway through this very difficult and lengthy process. Your ability to communicate with the patient and his environment calmly, kindly, without false optimism, and very patiently was a huge moral support for me, instilling faith in the possibility of my mother’s recovery. With a feeling of sincere gratitude and appreciation for the assistance provided.
Shamsutdinova Olesya
I, Olesya Shamsutdinova, am eternally grateful to the surgeon Alexander Shadzhievich for a qualified operation (removal of necrosis) on my mother. For his sensitivity, professionalism and desire to endure, understand, hope... because together it is easier to endure sorrow. Low bow to you.
Boris
Irina
In the summer of 2021, we were faced with a very unpleasant and scary problem. Due to a long stay in the hospital and the inability to move due to a broken leg, a bedsore developed on the back (in the lumbar region). In the hospital, unfortunately, it was neglected and at the time of discharge it was assessed at grade 4 severity. Friends advised me to see a doctor, surgeon Alexander Shadzhievich Garmaev. And I want to say that we didn’t regret it for a second. Alexander arrived on the same day, performed all the necessary procedures on the wound, and observed him for several days in a row. The doctor showed how to properly treat the wound and apply bandages. The problem was solved quite quickly thanks to well-chosen treatment and modern drugs. Alexander, thank you for your professionalism, for always being in touch and coming when necessary. The psychological support of the patient and family was invaluable.
Tatiana
Andrey
Complications from bedsores
Incorrect diagnosis, incorrectly determined stage of development of the lesion, ineffective treatment, and insufficient care on the part of service personnel can lead to the development of quite serious complications against the background of bedsores, including the death of the patient. The most serious consequences include the development of the following diseases.
- Erysipelas
- Phlegmon
- Sepsis
- Gangrene
Or erysipelas is typical for older patients with stage II bedsores. This is an infectious disease caused by streptococcus, which penetrates the wound through damaged skin. Treatment involves the use of sulfonamides, penicillin antibiotics, and nitrofurans.
It is an acute inflammatory process of the cellular space as a result of penetration of E. coli and staphylococcus through the wound surface. Among the main symptoms of infection: high temperature, redness, pain, swelling, purulent contents. Broad-spectrum antibiotics are prescribed. The source of the lesion must be opened.
It is also an inflammatory process that can occur at stages III-IV of bedsores. This disease affects the entire body, therefore, if treatment is not started in a timely manner, it often leads to death. Anti-inflammatory treatment is carried out using glucocorticoids. Detoxification of the body is mandatory.
At stage IV of development, bedsores can lead to the development of gangrene. The complication is accompanied by darkening of the epidermis, rapid tissue necrosis, and a putrid odor. Upon palpation, a specific crunch is diagnosed. Intramuscular injections are prescribed to protect the tissue adjacent to the wound from infection. Treatment is surgical and involves amputation if the limb is affected.
To prevent the development of these complications, it is enough to provide the patient with proper systematic care, regular hygiene procedures, and strictly follow the instructions of the attending physician.
Stages and symptoms
Bedsores can develop quickly, but the formation of bedsores and ulcers occurs through four stages (each of which has its own symptoms):
- Stage 1
Redness of intact skin. It is slightly inflamed and may be painful, itchy and warm to the touch. You may also notice that the texture of your skin has changed slightly. At this stage, bedsores on the heels resemble a sunburn. This initial stage is difficult to detect in people with dark skin.
- Stage 2
In the second stage, the first signs of skin damage appear. They look like abrasions, blisters or small pits. The outer layer of skin is broken, red and painful. The surrounding tissue may be pale, red, and swollen. The upper layers of tissue, as the most damaged ones, begin to die and peel off. Bruising at this stage indicates suspicion of possible deeper tissue damage, involving fat or muscle tissue.
- Stage 3
Complete loss of tissue. The damage extends to the deeper layers of tissue in the heel. Crater ulcers are present and are susceptible to infection. Subcutaneous fat may be visible, but no bones, tendons or muscles are affected. The depth of a stage 3 ulcer depends on its anatomical location. Most often, bedsores on the heels progress to stage 3, until others notice them and begin to treat them.
- Stage 4
Loss of tissue, opening of bone and tendons. Ulcers with black edges spread to the heel bone and can lead to the development of osteomyelitis (a purulent-necrotic process in the bone). The exposed calcaneus is visible or directly palpable at the bottom of the trophic ulcer. These ulcers are extremely difficult to treat and may require many months and activities to heal. Therefore, preventing the development of ulcers should be taken more seriously.
Classical medicine
Therapeutic and surgical treatment takes a lot of time and effort from the patient and the people serving him. For a quick and, most importantly, effective cure, it is necessary to constantly monitor the patient’s condition, evaluate the appearance of the skin, carefully remove keratinized, diseased tissue, carry out air baths and measures to maintain blood circulation at a normal level, observe preventive measures, use special mattresses for bedridden patients from bedsores, sheets, pillows and so on. The use of medications prescribed by a doctor is also mandatory.
Diaper rash cream
These are not therapeutic, but prophylactic agents. If bedsores have already formed, then there is no point in using them. They are used after hygiene procedures for bedridden patients. They are applied to areas and zones that are often and for a long time exposed to high humidity or are subject to compression. They help increase tissue turgor, dry the skin, and reduce areas of maceration.
Ointment
This dosage form is used to fight infections, as a stimulant to accelerate regeneration processes, and so on. They are used at stages III-IV of the disease to treat deep wounds and ulcers. The most commonly used medications of this type include the following.
- Vishnevsky ointment
- Levomikol
- Solcoseryl
- Oak bark
- Field chamomile
- Sea buckthorn oil
- Onion
- Potato
- Baking soda
It was developed in the middle of the last century by a group of Soviet surgeons. Can be used to eliminate foci of inflammatory processes caused by various microbes. To treat bedsores, it is applied to the affected areas twice a day and fixed with a medical gauze bandage.
A more modern product with an antimicrobial, dehydrating effect based on chloramphenicol. During the day, a single application is sufficient, after which the affected area is covered with a cloth or gauze.
A medicinal product that improves regeneration processes and blood microcirculation, which is due to the presence of calf blood extracts, vitamins, microelements, and nutrients. Used 2 times a day.
If there is positive dynamics, the prescribed ointment is used until complete recovery is achieved. Otherwise, it should be replaced with another, more effective drug or used in combination with another ointment.
Medicines
In addition to acting directly on the affected areas themselves, the doctor must also prescribe systemic drugs: antibiotics, antithrombosis, anti-inflammatory, to improve microcirculation, to relieve pain. The duration of the course and the dose of the drug taken are determined by the doctor depending on the patient’s condition. The course of treatment with antibiotics is usually from one to one and a half weeks, anti-inflammatory - up to 2 months.
Medicines are taken before the healing process begins, while the ointment is applied until the final epithelization of the affected surface.
Preparing to visit the doctor
Before visiting a doctor, do not treat wounds with ointments. To know how to treat bedsores, the doctor will also need information about all the patient’s illnesses and his condition. When accompanying a patient to an appointment, be prepared to answer all these questions: about the bedsores themselves, the reasons for the bedridden condition, the patient’s behavior and other points.
If the situation is advanced and the patient cannot be transported to the clinic in a wheelchair, then a doctor’s visit is required. The preparation is the same: information about the condition, as well as hygiene procedures without additional treatment of wounds.
