Bedsores

What are bedsores?

A bedsore is an area of reddened skin that progresses to breakdown of skin and underlying tissue to
form sores and ulcers. Bedsores are also known as pressure sores, decubitus ulcers, pressure ulcers
and pressure wounds.

What causes bedsores?

Bedsores are caused from a lack of blood flow and from mechanical stress to the skin and tissues over
a bony area that has been under pressure for a prolonged period. If blood supply is cut off to an area
of skin for more than 2 or 3 hours the skin is deprived of oxygen and begins to die. In addition, when
slowly sliding down a bed or chair, friction to the outer skin layer such as from wrinkled bedding and
clothing contribute to skin injury and ulcers. Excessive exposure to moisture such as sweat, blood,
urine or faeces also increases the likelihood of bedsores.

Who is at risk of bedsores?

People whom are immobile due to illness or injury are at greatest risk of getting bedsores. These
people may be wheelchair-bound or bedridden and are unable to change position without assistance.
Also at risk are people whom, due to nerve damage from injury or illness such as diabetes or stroke,
are unable to sense pain or signals that normally make people move. Elderly people are also at
greater risk because their skin is thinner and more fragile.

What are the signs and symptoms of bedsores?

Bedsores are classified into stages according to wound severity.

Stage Features

 Skin is unbroken but shows a pink or reddened area

1
 May look like a mild sunburn

 Skin may be tender, itchy or painful

2  Skin is red, swollen and painful

 Blisters that may be broken or intact may be present

 Upper layers of skin begin to die

3  Sore has broken through the skin and wound extends down to deeper layers of skin tissue
  Crater-like ulcers are present

 Wound is prone to infection

4  Sore extends past the skin and into fat, muscle and bone tissue

 Blackened dead tissue called eschar may be seen in deep opened wounds

Severe pressure ulceration

Most people with bedsores will feel some pain and itching. However, people whom have impaired
senses may not feel any pain even with severe deep sores.

What is the treatment for bedsores?

Bedsores can be difficult to treat once they go beyond stage 2. In the early stages when the skin is
still intact bedsores usually heal by themselves once the pressure has been removed. Once the skin is
broken the main aim is to prevent infection and protect the sore so that it can heal. Special
dressings and honey preparations may be used to help the healing process. Occasionally dead tissue
may be removed with a scalpel (debridement).

Therapeutic devices include:

 Topical negative pressure therapy (VAC®)

 Hydrotherapy debridement, using saline solution in a syringe or water pressure jets

 Warming therapy, using radiant heat in a moist environment to maintain skin surface
temperature of 37 to 38C

Deep bedsores are very difficult to treat and often require surgical treatment to remove dead and
decaying tissue. Sometimes healthy skin may be transplanted to the damaged area. Infections need
treatment with antibiotics. In severe or life-threatening situations amputation of limbs may be
necessary.
Can bedsores be prevented?
Bedsores can be prevented with intensive nursing care. Measures to prevent bedsores include:

 Correct malnutrition if present (fluid, energy, protein, vitamins and minerals)

 Daily inspection of an immobile person's skin to detect early redness

 Frequent repositioning of the patient (recommendation is to turn them every 2 hours)

 Keep the skin clean

 Special foam, fibre and gels as padding materials used on chairs and beds to relieve the
pressure on bony prominences

 Powered alternating-pressure mattresses and overlays

Prevention of bedsores is the best approach as established bedsores can be painful and life
threatening. They also lengthen hospital stays and increase medical costs dramatically.

Related information

References:

Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion

RH, Burton JL. Fourth edition. Blackwell Scientific Publications.

On DermNet NZ:

 Erosions and ulcers

 Synthetic wound dressings
 Honey for wound care
Other websites:

emedicine, the online textbook:

 Pressure Sores – Medline Plus

 Decubitus ulcers
 Pressure Ulcers, Surgical Treatment and Principles
 Pressure Ulcers, Nonsurgical Treatment and Principles
 Patient information: Pressure sores (The Basics) – UpToDate (for
subscribers)

Author: Vanessa Ngan, staff writer