Also commonly known as bed sores or pressure ulcers, pressure sores are areas of damaged skin and underlying tissues caused by staying in one position for too long. These sores commonly form where one’s bones are close to the skin such as at the ankles, back, elbows, heels and hips. This constant pressure exerted by the bone on the skin and the underlying structures over these regions causes a disruption of blood flow to these tissues. If this isn’t relieved for a longtime by changing position, it causes the cells to die off at the affected areas, finally resulting into serious wounding. In fact, one doesn’t usually need a long time in the same position to develop these pressure sores. Lying or sitting in one position for a period of 2 hours can be sufficient to result into developing pressure sores. We normally don’t get these as we sleep or sit because of constant involuntary movements and turnings that we make. People who are bedridden or wheelchair bound for whichever conditions, are at a high risk of developing these pressure sores. These are usually people who suffered spinal cord injuries and hence unable to move the legs or arms too, people suffering from brain conditions such as strokes. Generally any person who is confined to one position will develop these pressure sores if no special measures are taken. Other factors which increase one’s risk of developing these pressure sores include; poor nutrition status, diabetes, cigarette smoking, pre-existing diseases of blood vessels or the heart as well immune status compromise by other diseases such as HIV infection and cancer. Poor hygiene especially in patients who are unable to control their bladder and bowel due to conditions such as spinal cord injuries will increase their risk of developing pressure sores. Data from National Pressure Ulcer Advisory Panel (NPUAP) indicates that pressure sores develop in approximately 9% of all hospitalized patients, affecting 2.5 million people annually. For short term and long-term hospital care, the overall reported prevalence ranges between 3.5% and 29.5%. In addition to causing pain, suffering, and disability, pressure sores contribute to over 60,000 deaths per year (NPUAP statistics). Research has also shown that 20% of patients who are unable to move their legs and 26% of those unable to move both legs and arms develop pressure sores. For the majority of patients, wounds develop in either the supine (patient lying on their back) or seated position. Up to 75% of all pressure sores are located around the pelvis. These pressure sores appear on the affected area of the body differently according to the degree of severity. They initially appear as pale (whitish in colour) of otherwise intact skin. This can then progress to a visible wound on skin and can further worsen to a deeper wound with visible muscles or bone. Once the pressure sore(s) has formed, managing it involves; preventing complications resulting from the already existing sore such as life threating infections, preventing the pressure sore from getting bigger, preventing other sores forming on other parts of the body and surgery if deemed necessary for the sore to close. It is important to know that preventing these pressure sores among bed-ridden or wheelchair bound patients is possible, although requires a lot of commitment from the patient, caretakers as well as the nursing and medical team. Once the pressure sores have formed, they are not usually very easy to treat and hence the need for proper preventive measures. For bedridden patients, preventing these pressure sores involves; changing position of the patient at least every 2 hours and having them sit up in a chair for a few hours, watching out for any skin colour changes or small wounds, smooth beddings to prevent friction on the bed sheets, keeping beddings well dry and clean, placing extra soft paddings under places prone to these pressure sores such as the head, elbows, shoulders, ankles, hips, knees and tailbone. Special mattresses suitable for preventing these sores are available and very helpful. For wheelchair users, one should try to change their position every 15 minutes as well as appropriate cushions around the pelvis and the back. Proper nutrition, smoking cessation will help with minimizing the risks of developing these pressure sores as well as improve the healing ability of any existing ones. Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital, iangashugi@gmail.com
