Pressure sores

What are pressure sores?

Pressure sores develop when compression of the skin in one area of the body cuts off the blood supply, usually when someone sits or lies in one position for too long.

Symptoms

A pressure sore may initially appear as a red area of skin that doesn't disappear after a few hours. It may feel tender and become painful and purple in colour.

An open sore may develop when an area of tissue dies, which can sometimes become infected.

In severe cases the sore increases in size and depth (sometimes remarkably rapidly) and may cause such destruction of the fat and muscle layers underneath the skin that the bones are exposed. Very large sores, where the nerves are destroyed, may be remarkably painless.

Sores often develop on the areas that take the pressure when we sit or lie down, such as the:

• Hips.
• Buttocks.
• Base of the spine.
• Heels.
• Ankles.
• Shoulders, especially where bony prominences aren't protected by much fat.

Causes and risk factors

Ulcers are most likely to affect those with poor mobility who spend prolonged periods in bed or a chair, particularly if they're unable to change their position. They are a common problem in hospitals especially when people are too unwell to get out of bed, or undergo a lengthy operation.

Older people are more likely to develop pressure sores, which are also caused by poor nutrition, anaemia, recurrent infection and poor circulation.

Treatment and recovery

Treatment of pressure sores includes relieving pressure and keeping the sore clean. Dressings are used to encourage healing and antibiotic therapy can treat infection.

Removal of dead tissue, skin grafting and plastic surgery may also be required. It's important to improve nutrition and treat any underlying condition that's contributing to the problem.

The most important factor in preventing pressure sores is encouraging a person to change their position regularly throughout the day. Those unable to do this themselves should be moved at appropriate intervals (at least every two hours).

Special mattresses, such as air-filled alternating-pressure mattresses, and cushions that redistribute weight help to reduce pressure on sensitive areas. Protective padding of bony prominences should be also used.

Regular inspection of high-risk pressure areas is important to detect early signs and prompt medical care should be provided. Appropriate nursing care should be provided to ensure the skin is kept clean and dry.

A healthy diet that includes plenty of vitamin C and zinc is important to maintain healthy skin and may help prevent pressure sores developing.