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Definition

A pressure sore is a lesion that develops on the skin and underlying tissues due to unrelieved pressure. The skin and tissues need enough 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 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 fever or leakage of urine or stool.
  • Obesity —Extra weight increases pressure on the skin over the bones and joints.

Risk Factors

Factors that increase your risk of pressure sores include:

  • Immobility, such as being bed- or chair-bound
  • Sensory loss
  • Poor nutrition
  • Incontinence , or leakage of urine or stool
  • Increased 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

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Pressure sores are staged according to the depth and tissues that are involved.

Your bodily fluids may be tested. This can be done with:

  • Wound culture
  • Blood tests

Images may be taken of your bodily structures. This can be done with:

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:

Positioning

  • Avoid placing any weight or pressure on the wound.
  • Change position at least every two hours, around the clock.
  • Maintain good body alignment.
  • Make sure bedclothes are clean and without wrinkles.
  • If needed, use a special mattress.
  • Use a lift sheet to move the patient rather than pulling the bedsheet or the patient.

Hygiene

Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as recommended by the doctor.

Wound Care

You or your caregiver will be taught how to tend to the wound. Some basic instructions include:

  • Clean the sore, remove dead tissue, and apply a dressing.
  • Do not put anything else on the ulcer.
  • Wash hands before and after performing wound care. Wear disposable gloves.
  • Clean the wound every time the bandage is changed.
  • You may need to take pain medication a half hour or hour before dressing changes.

Nutrition

Eat a well-balanced meal. Your doctor may recommend vitamins, minerals, or supplements.

Surgery and Other Procedures

The doctor may surgically remove dead tissue. Skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.

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

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

Prevention

Most pressure ulcers can be prevented. Suggestions include:

  • Follow these tips when repositioning:
    • Change position in bed at least every two hours or, in a wheelchair, at least hourly. If able to move yourself, shift position every 15 minutes.
    • Maintain good body alignment.
    • Talk to your doctor about whether you should elevate the head of your bed.
    • 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 your 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.
  • Talk to the doctor about using:
    • A special foam mattress designed to reduce the risk of pressure sores
    • A mechanical mattress or overlay that inflates and deflates to change the pressure on the body
    • Sheepskin overlay
  • Use a special cushion for a wheelchair.
  • 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 stool 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.

Revision Information

  • Reviewer: Peter Lucas, MD
  • Review Date: 09/2013 -
  • Update Date: 12/16/2013 -
  • American Academy of Family Physicians

    http://familydoctor.org

  • National Pressure Ulcer Advisory Panel

    http://www.npuap.org

  • Canadian Family Physician

    http://www.cfpc.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • Pressure ulcer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed December 16, 2013.

  • Pressure ulcer category/staging illustrations. National Pressure Ulcer Advisory Panel website. Available at: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-ulcer-categorystaging-illustrations/. Accessed December 16, 2013.

  • 5/27/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4):CD001735.

  • 11/25/2013 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2013 Aug 18;8.