home Audience 4 Stages of bedsores in the photo and methods of their treatment. Why are bedsores dangerous? Who's at risk

Stages of bedsores in the photo and methods of their treatment. Why are bedsores dangerous? Who's at risk

Bedsores are areas of bleeding and necrosis of tissue that appear due to prolonged compression, shearing or displacement between the human skeleton and the surface of the bed. In order to avoid bedsores, it is necessary to know the causes of their occurrence, prevention and treatment methods.

Causes of bedsores

Many people know that the tissues of our body work only if useful substances enter with the blood. Blood vessels transport blood to all organs. The smallest vessels - capillaries, play important role in metabolism. But the flow of blood is very easy to stop if the vessels are crushed. In a patient who is constantly sitting or supine position, compression of blood vessels is observed. When a person does not change position for more than two hours, bleeding begins, and then tissue necrosis. Thus, the bedsore begins to progress. To prevent complications, it is necessary to use ointments to treat bedsores.

How does a bedsore develop? How to treat purulent wounds and bedsores?

Bedsores have four stages. The first stage involves tissue compaction and swelling of the area in which the disease develops. At this stage, bedsores are very easy to cure with the help of various medicines, such as GelePran, VoskoPran, ParaPran. At the second stage, erosions and ulcers already develop on the affected area. Only the top layer of the epidermis is affected. The second stage is not so easy to cure, but it is still possible. Ointments for the treatment of bedsores, which are also used at the first stage, will help with this.

The third stage is very difficult to treat. The tissues that are located under the epidermis are severely affected. Will help get rid of the disease the following drugs– VoskoSorb, GeliPran and MediSorb. These ointments are also successfully used for purulent wounds. The fourth stage involves severe damage and necrotic tissue changes. This stage can lead to blood poisoning. Treatment of stage 4 bedsores is possible with the help of MediSorb, GelePran. But ointments alone will not be enough; treatment must be coordinated with a doctor. Complex treatment will achieve complete cleansing of the wound.

In order to avoid bedsores, you must follow some rules. If the patient's condition is stable, his position must be changed every two hours. Change bedding regularly. Bedridden patients need to place a rubber circle under their back. If redness appears on the affected area, it should be rubbed with a dry towel. You can also wash the affected area with cold water or alcohol, and at the end of the procedure, powder the skin. An excellent means for preventing bedsores are disinfectant and antiseptic solutions. The main thing is careful care of the patient, and then treatment of even stage 4 bedsores will be simple.

Bedsores may form on the patient's skin. Treatment of bedsores is a very important activity that must be carried out according to all rules. An unpleasant defect occurs as a result of deterioration of blood circulation in the organs and tissues of a person forced to lead a sedentary lifestyle. Doctors recommend many measures that, if followed, will not cause bedsores to appear on the patient’s body. Treatment of bedsores and their treatment is a very labor-intensive and complex process. It is much easier to prevent them than to fight them.

What are bedsores?

In a person lying in one position for a long time, circulatory system not working at full capacity. Under the influence of the weight of the body, small capillaries are compressed. This prevents blood from flowing to certain areas. As a result, oxygen saturation and tissue nutrition stop. The latter, not receiving the necessary nutrients, begin to die off. It is in these areas that bedsores form. Treatment of bedsores, begun even before they appear, for preventive purposes, can radically change the situation. In most cases, such measures protect the patient from unpleasant and painful formations.

What do bedsores look like?

Skin death occurs in several stages. The type of bedsores depends on the severity of the stage:

In the first (initial) degree, areas of the skin that have been in a compressed state for a long time swell and turn red. looks like a simple irritation, sometimes with a blue tint. Pain may be felt in these parts of the body. With such symptoms, bedsore prevention should begin immediately. Treating compressed areas with camphor alcohol will provide excellent results.
The second stage is characterized by the formation of a shallow wound with pinkish and swollen edges on the irritated areas. It looks like an ulcer. Sometimes a bedsore in the second stage looks like a burst bubble.
In the third stage, the wound deepens. Yellow dead tissue can be seen inside it.
The fourth stage is characterized by an even greater deepening of the ulcer. It begins to affect inner fabrics. Tendons, muscles, and sometimes bones are visible in the wound hole.

The location of pressure ulcers depends on the patient's position. If the patient lies on his back, then ulcers form in the area of the shoulder blades, sacrum and heels. Bedsores on the hips, shoulders and knees occur in those people who are located on their side. In patients who use a wheelchair, ulcers may appear on the buttocks, sacrum, and back of the arms.

You should be aware of these areas and inspect them carefully. Do not forget that such people are recommended to treat bedsores daily and prevent them.

Causes

Bedsores appear in areas where there is no muscle tissue between the bones and skin. Ulcers occur in people who have lost the ability to move. For example, strict adherence to bed rest after operations or fixation of the human body as a result of injuries. Sometimes the cause of bedsores can be:

poorly applied splints and plaster casts;
incorrectly selected corsets and prostheses;
too tight bandages, folds in the bed, tight clothing.

Moreover, in some bedridden patients, such pathologies can develop quite rapidly. In such people, even with careful care, ulcers can form on the body. Such patients require more attentive care and frequent treatment of bedsores. In patients with diabetes, for example, blood supply is impaired. And if such a patient spends a long time in an immobile state, in which the tissues are compressed, then the risk of developing bedsores increases significantly. In addition, the following factors contribute to the formation of pathology:

Smoking.
Obesity.
Wrong diet.
Dehydration of the body.
Diabetes.
Diseases of the heart and blood vessels.
Increased sweating.
Traumatic or therapeutic disorders in the brain or spinal cord.
Allergic reactions to skin care cosmetics.

Preventive actions

Bedridden patients need special care. It is very important that bedsores are treated and prevented correctly. From the very moment the patient was bedridden. Such activities include:

Daily visual inspection of the patient's skin. In this case, it is especially necessary to carefully check the condition of the dermis in areas where bones protrude.
Treatment of bedsores in seriously ill patients with camphor alcohol (10% solution) or ammonia (0.5%). Such procedures are recommended to be carried out in “dangerous” areas and if there is no redness yet. During the event, light massage movements should be performed with a swab dipped in an alcohol solution. This massage helps blood circulation and stimulates tissues.
Periodically change the patient's posture. The patient's position can be changed using special means (for example, an inflatable ring or bolsters). Particular care must be taken to transform the position of the buttocks and heels to protect the integument from the formation of folds. A good remedy prevention is a special orthopedic mattress.
Be sure to use only natural fabrics for bed linen and clothing for the patient. Avoid elements that injure the skin (zippers, buttons, hooks).
Maintaining a comfortable temperature and humidity in the room where the patient is located.
Keeping the patient clean. The patient's skin should not be wet. Do not use products that may cause skin irritation.
Stimulation of the patient's motor functions. Turning and moving body parts, massage helps prevent bedsores.
Correct, balanced diet. It consists of foods that are low in calories but rich in minerals and vitamins. In this case, it is necessary to monitor water exchange. The patient should consume fluid, no more than one and a half liters per day.

These are the main activities that make up the prevention of pressure ulcers.

Skin treatment for bedsores

Therapeutic agents, even the most effective ones, will not be of any benefit if the area where the defect has formed remains compressed. It is impossible to eliminate the pathology unless blood begins to flow into this area, nourishing the tissues with the necessary substances.

Thus, care includes 3 main conditions:

restoration of blood circulation in the damaged area;
ensuring the rejection of dead tissue;
therapeutic measures aimed at wound healing.

Let's take a closer look at how bedsores are treated. The execution technique given below will allow you to complete the event correctly and efficiently.

Procedures to restore blood flow to the affected area

If a bedsore occurs, you must first avoid contact of the skin with the bed in the areas of irritation. To do this, place an inflatable circle or cushion under the body so that the wound is constantly in the air. A good preventive measure against bedsores is massage. Do it morning and evening. The patient's skin should be dry and clean. When performing a massage, you can use special creams and oils. Areas where wounds have formed are not massaged! Such treatment of bedsores in patients is possible only at the first stage.

Procedure:

Place the patient on his stomach. Stroking the legs from the heels to the buttocks.
Now move on to your hands. Stroke from the hands to the neck.
and the sacrum is performed downward, and then to the sides.
Stroking the entire back.

This procedure is performed within 5 minutes. The movements should be light at first and then more intense. Then they rub, vibrate and knead the same areas of the body. Each reception lasts 5 minutes. At the end, a head massage is performed, especially the back of the head, which is more at risk of developing bedsores. Then the patient is placed on his back and a similar massage is performed on the front of the body. Carefully massage those areas that protrude more (knees, ribs, pelvic bones).

Procedures for sloughing off dying tissue

Some patients develop bedsores very quickly. Treatment of bedsores, if there are wound surfaces, begins with freeing the affected area from dead cells and pus. For this purpose, special medications are used. IN difficult cases recommended surgical intervention.

Bedsores are treated:

Camphor alcohol. This remedy is used only in the initial stages. Its use on open wounds is completely unacceptable.
Hydrogen peroxide (3% solution).
"Chlorhexidine." The product is more neutral for the skin.

If you need to remove pus and dead cells, use special wound cleaning products: “Isuksol” and “Proteox-TM”.

Measures to ensure healing of the wound surface

After the ulcer is cleaned, it is necessary to begin treatment. Alginates and hydrocolloid dressings contribute to excellent healing of bedsores:

"Comfil Plus".
"Multiframe".
"Hydrocall."
"Hydrosorb".
"Duoderm".

The above products are quite expensive. Therefore, not all people can purchase them to treat bedsores. Treatment of bedsores can be carried out with special ointments and creams, which do not have such a high price. Among such drugs are:

To prevent infection, antiseptic rules should be strictly followed when treating ulcers. After applying wound healing agents, it is necessary to apply sterile bandage. If it is not possible to bandage the treated wound, you can fix the disinfecting pad at the site of the lesion with a special adhesive plaster. But it should allow the skin to breathe. It should be noted that bandages and adhesive plaster should not tighten the skin to prevent further damage. Dressings are carried out as necessary. Before each procedure, be sure to treat the bedsore with antiseptics. Sometimes, if indicated, patients are prescribed antibiotic treatment.

When is surgical treatment performed?

Unfortunately, even high-quality and effective treatment of bedsores in seriously ill patients does not always lead to healing of the wound surfaces. If conservative treatment does not help, surgical intervention is required. It is usually used for stage 3-4 bedsores.

Before surgical intervention perform the following procedures:

bedsore cleaning (to remove dead areas);
antibiotic treatment;
cleansing the body of toxins;
restoration of water, protein and electrolyte balance.

There are several surgical methods for the treatment of bedsores, which depend on the stage of development of the ulcer, the size of the affected area and the presence of infection:

Free Use for stage 2 and 3 bedsores. in 2-3 weeks.
Excision and plastic surgery of surrounding tissues. Carry out for stage 4 bedsores. The ulcer heals within 2 weeks in most patients.
Excision and plastic surgery with a skin flap with or without muscles. The operation is indicated for stage 4 bedsores and a large surface of dead tissue. The wound heals within 2-4 weeks in 2/3 of patients.

Sometimes only surgical intervention can help the patient get rid of bedsores and prevent complications such as renal failure, liver disease, sepsis and death. After surgery, the affected areas of the skin heal quite quickly. Surgical intervention can significantly alleviate the condition of seriously ill people.

Ointments for bedsores

The range of drugs for the treatment of these pathologies is quite large. In order to treat bedsores at home effectively on your own, you should choose the right medications. Ointments intended for the treatment of pathology should:

restore blood circulation;
stimulate tissue regeneration;
have an antibacterial effect;
eliminate pain.

However, do not forget about the technique of holding the event. Before using the ointment, the affected area should be disinfected and treated with an antiseptic. For this purpose, medications are used: “Chlorhexidine digluconate”, “Colloidal silver”, “Furacilin”.

Ointments for the treatment of bedsores are selected depending on the degree of development of the ulcer and the presence of infections. The first stage requires improved blood circulation and antimicrobial effects. At this stage apply:

Zinc ointment.
"Dermazin."
"Argosulfan".
"Tsindol."

When bacteria enter wounds, antibiotics are required. For such cases, at the first stage the following drugs are used:

"Argosulfan".
"Iruksol".
"Levomekol".
"Levosin".

In the second stage, ointments are used to remove dead cells. At the same time, they should have an anti-inflammatory and drying effect:

"Betadine."
"Methyluracil".
"Iruksol".
"Thiotriazolin".

At the third stage, ointments are shown that stimulate healing:

Fourth degree bedsores should be treated in a hospital, as there is a high risk of complications. Naturally, all ointments and remedies should be used only after consultation with your doctor. The specialist, based on the tests performed, will prescribe the best and effective therapy. Self-medication in this case is strictly contraindicated. After all, the risk is very high fatal outcome with inappropriate therapy.

Lecture 5. Prevention of bedsores

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1. Bedsores, places of formation, stages of development.

2. Factors contributing to the development of bedsores.

Bedsore is necrosis of soft tissues (skin with subcutaneous tissue, mucous membrane, wall of a hollow organ or blood vessel, etc.), resulting from ischemia caused by prolonged continuous mechanical pressure on them.

Potential places for bedsores to form include any area over bony protrusions on the body that are compressed when lying or sitting. In these places, the subcutaneous fatty tissue is least pronounced, and the pressure of the bony protrusions is most pronounced. Depending on the patient's position (on his back, on his side, sitting in a chair), the pressure points change. Most often in the area: auricle, thoracic spine (the most prominent part), sacrum, greater trochanter femur, protrusion of the fibula, ischial tuberosity, elbow, heels. Locations of bedsores

In the “supine” position, bedsores develop in the area of the back of the head, shoulder blades, elbows, sacrum, ischial tuberosities, and heels. In the “sideways” position - in the area of the auricle, shoulder, elbow joints, hip, knee joints, on the ankle. In the “sitting” position - in the area of the shoulder blades, sacrum, heels, toes. If the patient lies on his stomach - the pubic area and cheekbones.

Development of bedsores. Initially, a pale spot appears on the skin, then redness, swelling, sometimes accompanied by the formation of blisters in places where the epidermis is detached, then necrosis leads to exposure of the wound surface, infection of the wound, damage to the underlying tissues, even to the bone. With continued adverse effects, bedsores grow rapidly, sometimes affecting almost all areas of the body in contact with the supporting surface.

Clinical picture different with different stages development of bedsores:

Stage 1: persistent skin hyperemia that does not go away after the pressure stops; the skin is not damaged.

Stage 2: persistent skin hyperemia; epidermal detachment; superficial (shallow) violation of integrity skin(necrosis) spreading to the subcutaneous tissue.

Stage 3: destruction (necrosis) of the skin down to the muscle layer with penetration into the muscle; can be liquid discharge from the wound.

Stage 4: damage (necrosis) of all soft tissues; the presence of a cavity in which tendons and/or bone formations are visible.

Diagnosis of pressure ulcer infection is made by a doctor. The diagnosis is made based on examination data. The following criteria are used:

1) purulent discharge;

2) pain, swelling of the edges of the wound.

The diagnosis is confirmed bacteriologically by isolating the microorganism in cultures of fluid samples obtained by smear or puncture from the edges of the wound.

Confirmation of the existing complication of “bedsore infection” bacteriologically should be carried out in all patients suffering from agranulocytosis, even in the absence external signs inflammation (pain, swelling of the wound edges, purulent discharge).

Pressure ulcer infections that develop in a hospital are recorded as nosocomial infections.

A bedsore is open wound on the surface of the skin. In particular advanced cases it reaches the deep muscle layers, and is characterized by abundant necrotic tissue lesions, often with connection bacterial infections. Bedsores are formed due to mechanical compression local network small blood vessels with long stay the patient in one position. Such disorders, as a rule, occur in bedridden or sedentary patients who cannot or for some reason do not want to regularly change the position of their body.

Stages of bedsores and reasons contributing to their appearance

Mobility impairment is one of the most common reasons, causing the development of bedsores as a result of the compressive effect on the blood vessels of the subcutaneous tissue. Most often, bedsores are observed in visually impaired patients under anesthesia, suffering from severe psychopathological conditions, with a history of severe pathologies of the musculoskeletal system or central nervous system. nervous system recovering from major surgery or injury. Patients, for a number of reasons, cannot change the position of their body often enough, and the influence of their own body weight puts serious pressure especially on those areas of the skin that protrude above the general surface.

The second most important cause of the development of bedsores is the rupture of small blood vessels supplying a certain area of tissue, as a result of dragging the patient across the bed, pulling out from under him wet laundry or sheets, as well as moving the bedpan.

There are several complicating factors that, among other things, contribute to the development of pressure ulcers.

Limitation of joint mobility (contractures) and increased tone skeletal muscles (spasticity)

Prevents normal movement of the patient's body. Joint contractures most often occur with tendon injuries, arthritis, scar formations on the surface of the skin, or disorders of central nervous regulation. Severe injuries to the cerebral or spinal apparatus often lead to a spastic state of muscle mass in the limbs and abdominal cavity.

One of the most important stimuli for changing body position is pain.

Various neurological disorders or long-term use painkillers can significantly reduce pain threshold, thereby not informing consciousness about the need to reposition the body.

Increased pain sensitivity due to surgical or traumatic wounds

This may force the patient maintain a static position at all times.

A significant role in counteracting pathological processes as a result of squeezing blood vessels and nerve endings plays physiological state skin

Strong, elastic skin is sufficiently resistant to the development of bedsores. On the contrary, a thinned, atrophied epithelium, due to a reduced ability to regenerate, is quickly destroyed with an increasing deficiency of nutrients supplied by the blood. Such phenomena often occur when taking certain medicines, affecting water-salt metabolism in the body and hormonal drugs.

Decreased regenerative functions of the skin epithelium

Thinning of the skin-epidermal junction and organic destruction of the capillaries of the subcutaneous tissue are typical for patients old age. That's why The development of bedsores in older people always occurs faster and is fraught with complications.

The skin becomes more susceptible to even minor traumatic forces as a result of de-epithelialization, which usually occurs due to friction and shear forces when the patient is pulled

Worn areas on the skin have a reduced barrier of protection against bacterial contamination, and are also characterized by a low content of transepidermal water, which leads to maceration of the skin with its subsequent stratification.

Constant exposure to high humidity on the skin

May occur as a result of insufficient patient care also lead to damage to the outer skin. The situation is aggravated by the aggressive effects of substances contained in the patient’s feces and urine.

Dirty laundry

This is one of the main reasons for the development of pathogenic microflora in the formed ulcerative lesions on the skin. The temperature and humidity of the ulcer creates the most favorable conditions for the development of pathogenic microorganisms that are sufficiently resistant to local antibiotic therapy. The neglect of such processes often leads to a transition from a localized purulent-infectious process to a generalized form. In weakened patients Bacteremia, sepsis, myonecrosis or... often develop.

Malnutrition, insufficient protein intake, and anemia

They reflect the patient’s general condition of resistance against infectious and non-infectious types of skin lesions. Poor nutrition inhibits the body's immune system against pathogens. In addition, anemia results in poor oxygen carrying capacity of red blood cells. The situation worsens even more with the development of cardiovascular pathologies and hypovolemia.

Reperfusion

Restoring normal blood flow in the ischemic area, according to many experts, also contributes to the prolongation of necrotic processes. The metabolic products accumulated during the period of venous stagnation spread throughout the area of influence, thereby increasing the toxicity in this area.

In patients with normal sensitivity, mobility and the absence of psychopathological abnormalities, bedsores are extremely rare. Feedback from subcutaneous receptors signaling to the brain about the onset of ischemic processes in the area of compressive effects on blood vessels, forcing a person to change body position at a conscious or unconscious level.

The development of bedsores occurs in stages, and the further the stage, the more difficult it is to provide a therapeutic effect on ulcerative-necrotic formations.

First stage characterized by the integrity of the skin in the area of compression and the presence of persistent hyperemia for a long time after the pressure is removed.
Second stage - hyperemia of the subcutaneous tissue against the background early stages physical damage to the epithelial surface layers. Observe keratinization and detachment of the skin epithelium at the site of compression.
Third stage - formation of a deep, weeping ulcer with complete violation all layers of the skin and the transition of pathological processes of necrosis into the subcutaneous tissue and muscle tissue.
Fourth stage characterized by a very deep spread of pathological processes, right down to the bones and muscle fascia.

Pathophysiological basis of pressure ulcer formation

For the first time, the pathological processes of the formation of bedsores were described in 1873 by D. Paget, who quite accurately determined the development of necrotic processes as a result of compression of the local subnetwork of small blood vessels. The development of bedsores is influenced by many factors, but the process is always based on ischemic phenomena, leading to the destruction of the cell membrane, and subsequently to cell death as a result of insufficient tissue trophism.

From this point of view, bedsores develop from prolonged, constant pressure on the same area, which impairs the blood circulation of the same area of tissue.

For the development of ischemia it is necessary compression effect for arterial capillaries no less than 32 mm Hg and from 12 mm for venous capillaries.
Squeezing of arterioles contributes to a lack of influx of fresh blood saturated with oxygen and nutrients, and compression of venules significantly impedes blood outflow, rich in tissue metabolism products.
Accordingly, in addition to ischemic manifestations, they also observe stagnant processes in compressed tissues, which significantly complicates pathological process.

Typically, the tissues of a living organism are normally able to withstand much greater pressure than the indicators indicated above. This is facilitated by sufficient elasticity and strength of the cell walls. However, compression effects on the area for more than 2 hours overlap the tissue capabilities with trophic deficiency.

The development of bedsores most often occurs in areas of the skin that come into most close contact with surfaces. Pressure indicators on specific anatomical areas of the patient, depending on body position, are documented. Thus, when lying down, those most at risk of developing bedsores are:

sacrum;
heels;
back of the head

They are exposed to a pressure of about 40-60 mmHg. The chest and knees account for about 50 mm if the patient is lying on his stomach. In a sitting position, the ischial tuberosities are most subject to compression - about 100 mm Hg. It should be noted that the human constitution does not play a significant role in the development of bedsores - than bigger man, the more developed its cellular stroma is. The exception is overweight patients, but in them the pressure on the blood vessels is compensated using the additional shock-absorbing qualities of the fat layer.

Upon reaching the third stage, the pathological process accelerates, it is characterized by more severe damage muscle tissue, which is more demanding in providing oxygen and removing metabolic products. For this reason, the “point of no return” period is set at 2 hours, after which irreversible changes in muscle tissue begin. As for individual skins, they can withstand compression for up to 12 hours.

It is worth noting that, in addition to the immediate lack of blood supply, the processes of regulation of tissue activity in the compressed area are disrupted due to compression of the nerve endings.

Features of the localization of bedsores, symptoms and diagnosis

Pressure ulcers are usually described in terms of the location of the pathological area and the depth of involvement of the underlying tissue.

About 70% of all places where bedsores most often form are in areas of the ischial tuberosities, greater trochanters of the femur.
On heels, iliac crests, shoulder blades and elbow joints accounts for about 15-25%.
The remaining percentage is distributed to any parts of the patient’s body that come into contact with any surfaces for a long time, for example, when plaster casts are applied incorrectly.

It is worth noting that the formation of bedsores in oral cavity often found in the field of dentistry. The areas most often occur at pressure points of dentures, as well as in the interdental crevice space on the gum, which is facilitated by the packing of dense formations from food masses.

Usually, diagnosing a bedsore is not particularly difficult - visually and organoleptically it is possible to determine with a sufficient degree of confidence the development of ischemic processes in the area subject to compression. However, in cases where there is no improvement with correct treatment of pressure ulcers, it may be necessary additional diagnostics in order to identify third-party pathologies, including oncological ones. Besides, osteomyelitis must be excluded , especially in cases of deep pressure ulcers.

Complete blood count with differentiation may show an increased content of white blood cells, which allows us to judge the possible generalization of the pathological process beyond the pressure ulcer, as well as the development of an invasive infection. The erythrocyte sedimentation rate is higher than 120 mm/h and the leukocyte count is more than 15,000 cells/µl, forcing a series additional research for osteomyelitis.

Food quality, as an integral factor in favorable pressure ulcer therapy, is determined by the presence of albumin, prealbumin, transferrin and the amount of total protein in the blood serum.

A biopsy of wound tissue is performed if there is no improvement despite proper care of pressure ulcers. This survey is carried out to determine species varieties bacterial flora, populating the wound surface, as well as to exclude malignant cell growth. Whenever there is an exacerbation of a pressure ulcer that has been in remission for several months or years, a biopsy must be performed. This effect is most often observed during the development malignant processes in old wounds.

Briefly about the treatment and prevention of bedsores

It is worth noting that there is no panacea for treating bedsores. A series of consistent measures is required to facilitate rapid disposal of the developing pathological area.

The need for maximum restoration of blood circulation and innervation at the site of compression.
Removal formed necrotic masses in the pathological focus.
Promoting speedy healing formed wounds.

You should always remember that the appearance of a bedsore is an indicator of the patient’s neglect in terms of proper care and the correctness of the therapy used. Therefore, if the patient is unable to independently change the position of the body, it is necessary to assign service personnel to him, preferably in the person of the same person, who will always be aware of the individual characteristics of the development of possible pathological processes. Unfortunately, in the conditions of a modern Russian hospital, functioning with state support, this is an almost impossible task.

Absolutely all patients whose movement is limited by a wheelchair, bedridden patients, those suffering from paresis or paralysis of certain parts of the body, as well as diseases that reduce the level of brain activity need additional services. Special attention required for people with the following pathologies:

urinary and fecal incontinence;
are at the stage of exhaustion;
obese;
people with diabetes;
with a history of stroke complications.

What are the basic principles for preventing the development of bedsores?

Reduced compression, friction or lateral shear effects of the body.

Update: October 2018

Bedsores are serious complication many diseases associated with tissue malnutrition or resulting from external compression with displacement. IN medical practice Bedsores are often called ulcers.

This complication is by no means the fate of only bedridden patients; bedsores can form under any external pressure, especially often at the sites of bone protrusions.

Bedsores affect patients suffering from impaired tissue innervation due to pathology or damage to the spinal cord. In such patients, treatment of bedsores on the heels and buttocks becomes relevant, i.e. places receiving the greatest pressure from body weight.

In bedridden patients, compression of the skin and blood vessels occurs, resulting in stagnant processes and tissue death in places of maximum contact of the body with the hard parts of the bed, therefore bedsores are formed depending on the position of the body:

When lying on your stomach, the pubis and cheekbones are affected
When lying on the side - knees, hips, ankles
Lying on your back – sacrum, heels, ischial tuberosity, elbows, shoulder blades, back of head

This process is facilitated by overdrying or, conversely, excessive moisturizing of the skin. Dryness leads to exfoliation of the stratum corneum (protective) layer of the skin, and humidity provokes infection of the affected areas, all this is aggravated by impaired blood supply to areas of compression.

Such a complication as bedsores, their prevention and treatment are relevant to this day - the search for the latest means of treating and preventing these formations is constantly underway. Bedsores form quite quickly, but their treatment is problematic and does not always bring the desired effect.

70% of patients who develop bedsores are elderly:

66% - older people with hip (femoral neck) fractures
60% - patients with tetraplegia
33% patients in intensive care units
9% of hospitalized patients
3-25% - people at home (bedridden patients)

General approach to treating pressure ulcers

Methods and means of treating bedsores vary depending on the degree of the pathological process. Of great importance is the prevention of bedsores, which is actively carried out from the first days of the disease, which contributes to the appearance of this complication.

Treatment is divided into: conservative and surgical. The latter is shown when severe degrees bedsores that are difficult to treat and do not heal. All conservative treatment measures are aimed at achieving the following key points:

Improving trophism (blood supply) of tissues.
Cleaning the surface of bedsores from necrotic masses.
Healing of the surface of bedsores.

Principles of pressure ulcer therapy:

At each stage of development of a pressure ulcer, prevention of its progression is carried out.
It is unacceptable to use softening ointments, blind dressings that block the access of oxygen and evaporation of moisture, wet dressings in the initial stages and during dry necrosis - all this leads to the formation of wet necrosis and tissue death.
Ointments with antibacterial action are prescribed when a wet wound with purulent contents forms, or when there is wet tissue necrosis.
General antibacterial therapy is carried out taking into account the sensitivity of the pathogenic flora.

Superficial bedsores - stage 1-2

Treatment of bedsores 1st and 2nd degree

Anti-bedsore pillow with shape memory

So, how to treat grade 1 bedsores? When bedsores begin to develop, active prevention of the progression of necrotic tissue changes should be carried out, since at this stage only thickening and hyperemia of the skin occurs:

This event involves the use of special means:

plastic tires;
special anti-decubitus beds;
pillows, mattresses, pads, circles with gel, foam, air, water filling or a combination of several fillers;
systems with adjustable vibration and pressure.

Anti-decubitus mattress is the most effective means prevention of bedsores. Such mattresses constantly change the pressure on the body in different points, thanks to deflation and inflation of air every 7 minutes in special chambers of the mattress. Alternately changing pressure points eliminates the cause of bedsores and maintains normal blood circulation in the compressed tissues. Cellular type mattresses are used for the treatment and prevention of stages 1-2 (price 2000-2800 rubles), balloon type mattresses stage 3-4 bedsores (approximate prices 4800-9000 rubles).

You should also know simple rules when caring for bedridden patients:

The patient's skin should always be clean, not damp, and not dry - do air baths. For hygiene, do not use antibacterial soap (it also kills beneficial, protective bacteria), use plain soap, a natural sponge (or a cotton washcloth) and clean water. Do not rub the skin, but gently wipe it; after washing, do not wipe the skin, but blot it.
Carefully monitor the condition of the skin - if it is dry, then use moisturizers (moisturizing hypoallergenic creams, preferably baby cream) to which the patient is not allergic.
If the skin is too wet, without fanaticism you can use powders, talc or ointments that dry out the skin - a 1% solution of potassium permanganate, zinc ointment or brilliant green solution, but only for prevention or at stage 1, in the future you should not use ointments containing zinc and potassium permanganate solution.
Oily skin can be treated with alcohol-containing products.
If you find redness, do not massage it, massage only around the damaged skin. You can specially make a mitten from a terry towel and use it to massage.
If the patient has urinary incontinence, diapers or homemade pads made of cotton fabric should be regularly changed and the perineum should be toileted; for men it is better to use a urine collection system. At high temperature, or when the patient sweats profusely for other reasons, it is better to wipe the sweat with a weak solution of table vinegar - 1 tbsp. spoon for 250 ml. water than soap and water.

Local treatment of developing bedsores

This event requires a competent approach, since incorrect actions can provoke further development of necrosis.

Previously, the treatment of bedsores in bedridden patients was erroneously carried out with ion exchange drugs, such as chlorhexidine, iodinol, etc. However, these drugs change the permeability of cell membranes, kill leukocytes and reduce cellular resistance to bacteria.

Modern scheme local processing bedsores include:

Toilet the skin using saline or drugs that do not have ion-exchange properties - camphor alcohol.
Drying the skin and treating with drugs that improve local tissue circulation (Solcoseryl).
Xeroform powder helps with bedsores.
Applying a polyurethane film dressing. This modern dressing material is produced in the form of a transparent film with an adhesive surface and provides protection against bacteria, access of oxygen to tissues and evaporation of moisture, and also allows visual monitoring of the condition of the skin. When gluing such bandage patches, excessive tension should be avoided, since small folds form when the patient moves, which aggravates the condition.
A technique such as washing the skin with cold water also works well. The contraction of blood vessels and their subsequent compensatory expansion leads to improved local blood flow and increased tissue nutrition.

How to treat stage 2 bedsores?

This stage represents a transitional state of the skin, when minor superficial damage is already visible. At this stage, minimal surgical intervention and measures are carried out to stop tissue necrosis and promote regeneration of damaged areas:

Toilet the formed wound by removing dead epidermis from the blistered areas. Ideally, it is carried out in a dressing room: cutting off dead epithelium with surgical scissors, washing the wound with saline solution, hydrogen peroxide.
Observation of pressure ulcers in dynamics with assessment of the development of the process.
Antibacterial therapy in case of progression of bedsores and the onset of an inflammatory reaction.
Applying antiseptic dressings to bedsores devoid of epidermis, after consulting with a doctor, which dressing is best to use for treating a given wound surface, taking into account the stage (presence, absence of necrosis), area of damage:

Treatment of bedsores 3 and 4 degrees

At stage 3 of pressure ulcer development, necrosis of the dermis and subcutaneous fatty tissue to the fascia occurs. Treatment of grade 3 bedsores is aimed at surgical cleansing of the wound from necrosis and purulent exudate and further absorption of wound discharge with protection from drying out.

The peculiarity of necrotic changes in bedsores is the rapid spread of the pathological process to adjacent tissues with poor blood supply. The wrong tactic in this case is to expect the dead tissue to be rejected on its own and the wound to cleanse. Necrectomy with opening of purulent cavities is recommended to be carried out before the appearance of capillary bleeding.

After necrectomy, the pressure ulcer is sanitized using antibiotic therapy, local antiseptics and other drugs. Groups of drugs used in the treatment of pressure ulcers:

Complex treatment allows you to stop the septic condition and achieve cleansing of the ulcer. Local treatment is carried out using the following popular drugs of choice:

Argosulfan cream

The active basis of which is the antibiotic sulfathiazole, which inhibits the growth and further reproduction of pathogenic microorganisms. An auxiliary active ingredient is silver ions, which enhance the therapeutic effect of sulfathizole and at the same time reduce its sensitizing (allergic) effect. action, and also inhibit the growth of bacterial flora.

The hydrophilic base of the drug provides an analgesic effect, moisturizes the wound and accelerates its healing. The concentration of the active cream base in the wound remains at the same therapeutic level for a long time, and minimal resorption ensures the absence of toxic effects.

Formed bedsores can be treated with Argosulfan ointment in an open manner or used with an occlusive dressing. The drug is applied to the entire surface of the cleaned wound, 2–3 mm thick, twice or thrice a day. Can be used for up to 2 months.

Ointments Sulfargin (50g 200 rubles) and Dermazin (50 grams 200 rubles, 250 grams 530 rubles), Argosulfan (15 grams 200 rubles, 40 grams 350 rubles) have a similar effect.

Ointment Iruksol

The active composition of the ointment contains: collagenase, chloramphenicol and related enzymes. This enzymatic preparation ensures the cleansing of bedsores, the breakdown of anesthetized tissue, which deprives bacteria of a nutrient medium, as well as a bacteriostatic effect. The use of Iruksol on cleaned tissues ensures their rapid granulation.

Apply to a cleaned or moistened wound with saline solution twice a day until the wound is completely cleansed and tissue granulation.

Iruksol ointment, price approximately 1300 rubles. for 30 gr.

Levosin ointment

The drug is based on the antimicrobial substances chloramphenicol and sulfadimethoxin, the wound-healing component methyluracil and local anesthetic trimecaine. The ointment has high hydration activity, thereby providing a rapid therapeutic effect. The use of ointment leads to cleansing of the pressure wound from pus and necrotic masses and subsequent healing of the wound.

Apply daily to a cleaned surface, which is loosely filled with ointment and covered dressing material. It is possible to administer it into purulent cavities through a syringe.

Levosin price for 40 g. 80 rub.

Levomekol

- in addition to methyluracil, the composition includes chloramphenicol. This drug improves tissue regeneration and has antibacterial properties. Used for infected bedsores in the purulent-necrotic phase of the wound process.

Levomekol (price 80-100 rubles)

Metronidazole gel 0.75%

Metrgil is based on a substance with antimicrobial effect Metronidazole. The gel is used with dressing material and provides relief from the stench of pressure ulcers and inhibition of microbial growth. For bedsores with copious discharge, foam dressings with metronidazole are used, for dry bedsores or with insignificant discharge, hydrogel dressings with metronidazole are used.

Metrogyl gel price 100-120 rub.

Hydrogel Intrasite - for cleansing the skin of necrotic tissue

For gentle cleaning of necrotic skin tissue in bedsores. The hydrogel is recommended for use with an external dressing, the frequency of change of which and the choice of dressing depend on the condition of the pressure ulcer. It provides gentle, quick cleansing of the wound from necrotic tissue, as it adsorbs excess exudate and wound detritus. Intrasite is a pure amorphous hydrogel containing water, propylene glycol and a modified carboxymethylcellulose polymer.

Price: Gel INTRASITE 2100 rub. (Great Britain)

At stage 4 of the formation of a pressure sore, deep necrosis occurs with the involvement of muscles, tendons, joint capsules and bones in the pathological process. Treatment includes excision of necrosis, absorption of pressure ulcer fluid, and moistening of the healing ulcer.

With conservative treatment, if the size of a deep pressure ulcer does not decrease by 30% in 14 days, then the extent and severity of the patient’s condition should be re-evaluated and the treatment method should be changed. After stopping acute phase course of the ulcerative process, the issue of surgical treatment.

Complete surgical excision of all dead tissue is impossible and impractical (it is quite difficult to accurately determine the border of necrosis). Surgical cleansing of the wound is carried out with the maximum possible preservation of living tissue in the areas of the articular capsules of the neurovascular bundles.

Drug therapy is similar to that used in the treatment of grade 3 pressure ulcers.

During surgical treatment and to stimulate tissue repair, physiotherapeutic treatment of bedsores is carried out:

Reducing microbial contamination of ulcers - ultrasound, UHF in a thermal dose, phonophoresis of antiseptics.
Stimulation of reparative processes - darsonval of healthy tissues surrounding the bedsore (see), low-intensity laser, mud applications, direct current, electroacupuncture.
Stimulation of blood supply and microcirculation - massage of healthy tissues bordering bedsores.

Surgery

Surgical treatment is carried out according to strict indications, since improper and inappropriate intervention is likely to increase the area of the bedsore. The effectiveness of surgical treatment methods is assessed in order to avoid further complications.

Free skin plasty (autodermoplasty), excision of a bedsore with comparison of the edges of the wound, and plasty with local tissues are used. Unfortunately, not always this treatment effective, since the transplanted tissue does not take root well in a place with insufficient blood supply, and the pressure ulcer is a priori non-sterile.

Early surgical complications include accumulation of exudate under the skin flap, suture dehiscence, marginal necrosis of the skin flap, wound necrosis, and bleeding. In the future, a fistula may form, forming a purulent cavity and leading to a relapse of the bedsore.

Treating bedsores at home

Treatment of bedsores in bedridden patients at home is very important and presents certain difficulties. It is difficult to carry out complete cleaning at home purulent wound and ensure good gas exchange for surface drying and tissue repair. Modern industry produces convenient disposable antiseptic self-adhesive dressings, made of innovative materials and applicable for different stages of bedsores, infected or not, which must be taken into account when choosing them.

Proteox-TM with trypsin and mexidol

Used to treat infected bedsores in the final stages.
Clears ulcers of purulent masses, necrosis, stimulates the repair process, relieves inflammation. (price 180 rubles).

Multiferm - complex of enzymes and chitosan (Moscow)

Treatment of bedsores with and without slight exudation, infected or not, grades 1 and 2.

Exposure time of 1 bandage (10x10cm) 24-48 hours (price 180 rubles)

Biaten AG (Denmark)

Treatment of bedsores with a large weeping surface, infected.

The course of treatment is 1-10 dressings, the frequency of changing dressings is once every 1-7 days (as they become soaked). Price 950 rub.

Comfil plus (Denmark)

Treatment of large bedsores with and without slight exudation, uninfected. (price 140 rubles)

Traditional treatment of bedsores

When bedsores form, treatment folk remedies is an auxiliary measure that helps cleanse wounds and form new tissue. It should be remembered that almost everything traditional methods imply the use medicinal plants, which can cause an allergic reaction if the patient is hypersensitive, and also depend on the stage of the process, so before using them you should consult a doctor about the advisability of such treatment. Can not use herbal remedies with tanning effect - willow bark, green infusion walnut, oak bark, acorn oil, etc.

Freshly squeezed juice from lungwort leaves is applied to the area of the bedsore several times a day.
Leaves of Kalanchoe officinalis, cut in half, are applied with the cut to the bedsore and secured with a bandage overnight.
Young black elderberry leaves, scalded with boiling milk, are applied to the surface of the bedsore 2 times a day.
Ointment from calendula flowers (1 tablespoon of crushed flowers mixed with 50 grams of petroleum jelly) is applied to bedsores 2 times a day.
Lotions of fresh crushed potatoes mixed with honey in a 1:1 ratio are applied to areas prone to the formation of bedsores.
Oil tea tree or several times a day, lubricate areas with bedsores (stage 1-2).
and, mixed with honey in a ratio of 2:2:1, applied to areas with bedsores 2 times a day.
A compress of sterile fish oil based on a sterile napkin is left overnight.
Sprinkling bedsores with starch.

Complications of bedsores

Bedsores can lead to purulent arthritis, phlegmon, wound myiasis (when adult flies lay eggs on the wound surface). When the walls of blood vessels are corroded, arrosive bleeding can occur, and with persistent non-healing bedsores, the risk of skin cancer increases.

The most severe complication for bedsores - sepsis, when an infection from a wound spreads throughout the body through the bloodstream, leading to multiple organ failure and death.

Prevention of bedsores

When preventing bedsores, it is worth considering the provoking factors and risk factors for their occurrence:

Dirty skin, crumbs and other particles, folds, buttons, rough seams on bed linen
Fecal and urinary incontinence, allergic manifestations the patient for hygienic care products
Obesity, diabetes, ),
Poor nutrition, exhaustion of the body, insufficient drinking
Smoking, diseases of blood vessels and heart, brain and spinal cord
Fecal and urinary incontinence
Continuous pressure, humidity, friction
Men are more likely to suffer from bedsores
Age - over 70 years old
Immobility or broken bones
Low arterial pressure, anemia, malignant tumors, stroke
Dry skin, swelling

Prevention of bedsores should be carried out from the first day of the disease, with special persistence and thoroughness. As practice shows, if a bedsore has already begun to form, it is quite difficult to prevent its progression, and each subsequent stage of a bedsore increasingly reduces the chance of spontaneous resolution of the pathological process.

Prevention includes the following activities:

Thorough skin care - cleansing, non-contact drying and disinfection.
Regular change of bed linen, even stretching of sheets without wrinkles.
The use of special mattresses (water, pneumatic, vibration), circles and pads.
Constant change of position of the patient (every 2 hours).
A balanced diet with proper drinking regime.
Imitation of muscle work - massage, special electric underwear.