Those people whose relatives have been “bedridden” for a long time due to their poor health, as well as the patients themselves, who have to stay in bed for weeks and months, are well aware of pressure sores. These wounds on the body of patients, already weakened by the disease or undergoing a serious operation, give a lot of unpleasant sensations.
If you do not pay attention to them in time and take measures, they can spread deep into the epidermis, affect the dermis, even expose the bone tissue. How to treat bedsores at the initial stage of their appearance, so as not to aggravate the problem? How to alleviate the suffering of the patient, if the moment is missed, and pathological deformities have already affected muscle tissue? How does this threaten the patient? How to treat bedsores at home? We will answer all these questions in our article.
Pressure Sores General
Briefly repeat the device of human integumentary tissues. Everyone knows that the skin is designed to protect internal organs from environmental influences. Each person, regardless of whether he is an adult or just born, has many layers of skin. The uppermost one is the epidermis. It is on it that we observe the first signs of pressure sores. How to treat them will be described a little below. For now, we note that the thickness of the epidermis is very small - from just 0.05 mm (on the eyelids) to 1.5 mm (on the feet).
Below it is the dermis. It accounts for about 90% of our skin. It consists of two layers - papillary and mesh. In the dermis are hair bags, blood and lymph vessels, sebaceous glands, nerve endings, collagen fibers, sweat glands.
Hypodermis (in other words, subcutaneous fatty tissue) is located under the dermis. The thickness of this layer may vary depending on obesity. The hypodermis in the composition has connective tissue, nerve endings and many fat cells, between which there are also blood and lymph vessels.
Next are the fascia (sheath of connective tissue), muscle fibers, bones.
According to medical statistics, in Russia, 90% of bedridden patients have pressure sores. How to treat such wounds on the buttocks, tailbone and other parts of the body? The techniques have long been developed and are constantly being improved, but the problem remains acute. The main reason is the poor medical equipment of Russian hospitals, as well as the insufficient responsibility of health workers who are required to monitor the condition of the skin of bedridden patients. For comparison, we say that in European countries only 30% of patients have pressure sores.
In size, such wounds can be different - from very small (only a few mm in diameter) to gigantic (with a diameter of more than 20 cm).
Where and why bedsores occur
From the above information it is clear that lymph and blood are constantly circulating in the dermis and hypodermis of the skin, and the epidermis protects these layers from any negative external influences. When squeezing the skin, the movement of fluids in these areas stops. If this compression lasts more than 2 hours, necrotic changes in the tissues, called pressure sores, begin. How to treat them at the very first stage of development? In most cases, it is enough for a person to regularly do a light massage of the skin (rubbing) and often change his body position. Otherwise, the necrosis that began in these places spreads to all layers of the epidermis, and after it to the cells of the dermis.
Most often, such wounds form on bulging areas of the body that are most in contact with the surface of the bed:
- Buttocks.
- Heels
- Shoulder blades.
- The back of the head.
- Sacrum.
- Elbow joints.
Depending on the position of the person in bed, bedsores can be observed in such parts of the body:
- Lap.
- Toes.
- Ribs
- The area of ​​the sciatic bones.
- Large trochanteric femur.
- The area of ​​the ilium.
- Head and ears (in rare cases).
How to treat bedsores in bedridden patients in the hospital, in each case, medical professionals must decide. They are required to perform basic therapeutic manipulations. Relatives can take part in the treatment process by turning the patient upside down, sitting him on the bed (if his health condition allows), stroking and kneading problem areas of his skin (at the initial stage) to increase blood and lymph circulation in them.
The etymology of the word “bedsore” is based on the fact that the defect is formed with a long lying position. However, such a pathology can occur in people who are actively moving. We are talking about pressure sores in the mouth, resulting from rubbing the mucous membranes with poorly fitting dentures.
In addition, such wounds often appear in people with fractures of the limbs - due to rubbing and squeezing the skin with plaster bandages.
Classification
Depending on how far the necrotic process of the skin has gone, there are 4 stages of bedsores.
I is the very beginning of the pathology. So far, only persistent hyperemia can be seen on the skin, but the epidermis is not broken. Some patients are not bothered by anything in these places, others experience discomfort, sometimes burning pain and / or itching. By the sign that the redness does not pass after the exclusion of compression (nothing compresses the skin, but its normal color does not return), a bedsore can be diagnosed. How to treat such a pathology? So far, the therapy does not cause any particular difficulties. It can be done by people who are even very far from medicine.
II is a continuation of the development of stage I bedsores. Such a wound can still be treated with conservative methods. At stage II, there is a violation of the integrity and stratification of the epidermis, the penetration of pathology into the layers of the dermis, but the hypodermis is not yet affected. In the place of the bedsore, hyperemic skin and a bladder filled with liquid exudate can be seen. When the patient moves or careless manipulations of the medical staff, he bursts, exposing a very painful bright red area of ​​the dermis. At this stage, without treatment, any infection easily gets into the wound, which will cause suppuration and deterioration of the patient's condition.
III - this stage is characterized by the continuation of the spread of cell necrosis deep into the skin of the patient. Pathology extends to the hypodermis, but the muscle layer and fascia are not yet affected. The visual pressure ulcer at stage III looks like a deep wound with wide edges and a tapering bottom, where a layer of yellow dead tissue is visible. How and how to treat bedsores in a patient at this stage? In most cases, doctors try to use conservative methods. According to medical statistics, only in 25% of cases, surgery is performed.
IV - the most difficult and dangerous stage. Necrosis extends not only to the tissues of the skin and muscles, but also to the tendons, bones. In some cases, they are visible in especially deep wounds, but more often a dead, dark-colored tissue is visible at their bottom. At this stage, bedsores how to treat? At home, therapy is not possible, since the patient requires surgical intervention. Consider its features.
Surgery Treatment
Doctors, even if the patient has stage IV pressure ulcers, first try to conservative therapy, because it costs five times cheaper (according to the estimates of American doctors). Other reasons for refusing surgery:
- Long (up to 3 months) stage of preparation.
- A very long period of rehabilitation.
- Technical difficulties (and sometimes impossibility) to perform surgical treatment.
- A weak effect or its complete absence after the first operation (often it is required to repeat this effect several times).
Telling how and how to treat bedsores in a patient, we explain what is included in the preparation for the operation. In any necrotic ulcer, all kinds of pathogenic microorganisms are sure to gather, which can cause suppuration, intoxication, and a severe septic state. It is because of this that about 20% of patients who have pressure sores die.
Preparation for surgery includes:
- Antibiotic therapy.
- Recovery of electrolyte balance.
- Bringing protein balance to normal.
- Detoxification.
- Restore water balance.
- Remediation of the wound.
- Complete removal of dead tissue.
- Further work with pressure sores until vascularized granulations appear in it. If this does not happen, the operation is not done.
It is clear that there can be no question of performing such manipulations at home. How to treat pressure sores in the preoperative period? At the present stage of development of medicine are used:
- Bandaging wounds with antiseptics and enzymes.
- Stimulation of tissues for regeneration using magneto and electrotherapy.
- Exposure to a wound by a defocused laser beam.
The latest innovation has reduced the training period by 3 times.
Surgical intervention is performed according to the following methods:
- Skin plastic (a flap of skin taken from the patient’s body is sewn onto the wound).
- Excision of a bedsore and further plastic surgery using adjacent skin areas (combining wound edges).
- Excision with further use of flaps taken from other parts of the body.
After surgery, complications are often observed associated with insufficient preparation of a bedsore for it, poor patient care, infection of the wound, tension of its edges, and rejection of the implanted skin fragment.
If bedsores of the III and II degrees do not heal for a long time or often recur, their treatment is also carried out surgically.
Conservative therapy of bedsores of the III and IV degrees
Regardless of the severity of the pathology and the place of its localization, the first thing to do is to remove or at least weaken the compression. This is most difficult to achieve in patients with spinal cord and spinal cord injuries. This question is easier to solve if a person has wounds from a long lying on the limbs. For example, before treating a pressure sore on the heel, a pillow, a folded blanket or any other similar object is placed under the patient’s leg in the calf or lower leg area. It must be placed so that the heel does not touch the surface of the bed. For bedsores on the coccyx or buttocks, another decompression method is used using inflatable pads.
Therapy of bedsores of the III and IV degrees is carried out exclusively in a hospital. The wound must be cleaned of pus (if present) and dead tissue.
Next, sterile dressings with ointments are applied:
- Thiotriazolinum.
- Bepanten.
- "Algofin."
- Iruxol.
- "Solcoseryl."
Drug therapy is carried out with the help of drugs:
- Antibiotics.
- Necrolytic agents, which include trypsin, collagenase, terrilithin, deoxy ribonuclease.
- Hyperosmolar preparations externally in the form of ointments and liniment, which draw pus from the wound, as well as products of necrosis.
- Angioprotectors (improve microcirculation of biological fluids in tissues).
- Anti-inflammatory drugs (Prednisolone, Hydrocortisone,
- "Dexamethasone").
- Regenerative stimulants (Vinylinum, Methyluracil, Stellanin).
- Preparations containing silver (Argokrem, Dermazin, Argovit and analogues).
In addition to drug therapy, patients are prescribed physiotherapy: UHF, electrophoresis, ultrasound, electrotherapy.
Therapy of bedsores of the II degree
Recall that with this pathology, tissue necrosis already takes place, but so far it is spread only to the epidermis and dermis. These structures tend to recover quickly. Therefore, it is possible, without resorting to emergency measures, to treat such bedsores at home. How to do this? The main and immutable criteria of therapy:
1. The ideal cleanliness of the patient’s clothes and bedding.
2. Ensuring the removal of compression. For example, how to treat a pressure sore on the tailbone? This part of the skeleton is the lower part of the spine and is represented by several rudimentary fused vertebrae. In fact, this is a modified tail. The coccyx plays an important role, since many ligaments and muscles that are involved in the work of the intestine and urogenital system are attached to it. It is located above the buttocks.
In patients constantly lying on their backs, layers of skin, muscles and ligaments are compressed. Since there are almost no hypodermis in this part of the human body, bedsores here develop very quickly. The situation is aggravated by the fact that the coccyx site is often in conditions of high humidity, as the patient commits acts of urination and defecation for himself. The same picture is observed with bedsores on the buttocks. This part of the body is most affected by moisture and stool, and therefore requires very thorough hygiene.
In order to avoid pressure sores, and also in case of their appearance, the patient needs to be turned every 1.5-2 hours from the back to the right or left side. If it is difficult for him to maintain such a position, it is required to put a blanket rolled up under his back. The best option is to buy a special medical bed and an anti-decubitus mattress (it is equipped with cells into which air is forced).
In the matter of how to treat pressure sores on the buttocks at home, decompression using such a mattress is also very relevant. If it is not, you can take the advice of folk healers and sew a small pillow (the size of the buttocks), which you need to fill with millet, rice, lentils or wheat.
It is possible to provide decompression with the help of special inflatable rubber pads with a hole in the center, which must be placed under the back in the coccyx so that it does not touch the bed.
3. Massage. It must be performed with light stroking movements, almost without exerting pressure. The wound itself cannot be kneaded, only the skin around it. Massage is needed in order to improve blood and lymph circulation.
4. Sanitation of the wound. This is one of the highlights on how to treat pressure sores at home. Any sanitation of injured surfaces must be carried out with sterile gloves. If there are none in the house, the person who performs the procedures must wash their hands thoroughly, and then treat them with an alcohol solution. With bedsores of the II degree, blisters appear with exudate inside or an open wound if the skin of the blister breaks. Sanitation must be performed as follows:
- Remove the previous dressing.
- With a disinfectant solution (you can use Chlorhexidine), wash the wound surface, while removing the remaining cream or ointment, as well as peeling or exfoliating skin.
- Rinse the disinfectant with saline.
- Dry the wound carefully (without wiping) with sterile wipes.
- Apply a bactericidal healing spray or cream.
- Close the bedsore with a sterile dressing.
The entire algorithm of this procedure should be carried out every time after contamination of the dressing in the course of acts of urination or defecation of the patient, or scheduled once a day.
As therapeutic agents that are applied to the wound, creams and ointments “Vinin”, “Levosin”, “Levomikol”, “Dermazin” and their analogues can be used.
5. Provide the patient with quality nutrition.
Therapy of bedsores of the I degree
This is the most favorable (so to speak) type of bedsores, since in this case the surface of the skin is not broken. At the first stage, a painful redness may appear at the site of the future wound. Sometimes it itches, very rarely flakes. In some people, hyperemia is not observed. They only feel a burning sensation or any other discomfort in that place. These harmless symptoms require increased attention and urgent action.
For example, how to treat pressure sores of the heels? The skin on them in most people has virtually no hypodermis, so the depreciation between the bones and the surface of the bed is very weak. Patients constantly lying on their backs begin to feel a burning sensation in their heels, but hyperemia occurs in a small part of patients. It was already said above that the patient needs to ensure such a position of the legs so that his heels do not touch the bed.
In addition, a person needs to be turned from back to side, and if health allows, then seated so that he lowers his legs to the floor.
It is very important to regularly knead his heels, then lubricate them with camphor or salicylic alcohol, and then apply angioprotective (improve microcirculation) and anti-inflammatory drugs. For these purposes, use "Dexamethasone", "Pentoxifylline", "Troxevasin" and others.
ethnoscience
The healers have accumulated rich experience and are well aware of how to treat bedsores. The photo below shows the preparation of one of the potions.
The simplest and most accessible method that can be used for bedsores of the II and even III degree is applying to the wound an aloe cut along the leaf (inner side to the wound) or chopped Kalanchoe leaf.
Some doctors advise attaching a clean cabbage leaf overnight to the inflamed wound with a bandage.
Fir oil is used as a bactericidal agent for treating wounds and for compresses. It is necessary to add a few drops to boiled water.
The well-known calendula (marigolds) also has high anti-inflammatory and antibacterial effects. An ointment is prepared from it as follows: crushed dry leaves without observing strict proportions are added to petroleum jelly and mixed well. The resulting product lubricates the wounds several times a day. In addition, you can drink calendula and chamomile tea daily, adding honey to your taste.
For a long time, the mummy has proven itself from the best side. You can buy its solution in any pharmacy. Mummy should be applied to a napkin and applied to a damaged surface.
What is the danger of pressure sores
The appearance of such wounds on the skin violates the immune status and significantly reduces the patient's ability to withstand the underlying disease. The main danger of pressure sores is the possibility of infection, which leads to the development of sepsis. Any infection inevitably entails intoxication of the body. Also, patients often have anemia, hypoproteinemia (a decrease in the amount of protein in the plasma), amyloidosis of the internal organs, leading to renal and liver failure.
Bedsores in the elderly are especially dangerous. How to treat such people? It is necessary to take into account the following age-related changes:
- A decrease in the amount of fatty tissue, which negatively affects its function of depreciation.
- A decrease in the activity of the immune defense, as a result of which they are more often susceptible to various diseases than young ones
- The weakening of tissue regeneration activity, that is, injuries appear more often in them than in people of other age categories, and the treatment is harder and longer.
- Many older people suffer from various diseases of the internal organs. They often have problems with the work of the intestines and stomach, with heart and pressure.
These reasons may be a contraindication for surgical treatment, so all hope is only for conservative therapy.
The rules for its conduct in the elderly do not differ from those described above. It is important to provide these people with food rich in vitamins, proteins, trace elements. They also need to maintain water balance in their bodies. Elderly need to drink at least 1.5 liters of mineral still water per day.
Of course, it is necessary to observe their hygiene, often change the absorbent diapers, while washing the genitourinary organs, make sure that there are no wrinkles on the clothes and sheets, there are no crumbs from food.
Prevention
Doctors believe that the appearance of pressure sores in seriously ill patients is an inevitable complication. A particularly sad picture is observed in our country. In many Russian hospitals, even beds with automatically rising backs are a rarity, and there is no need to talk about anti-decubitus mattresses. Therefore, all responsibility for the skin condition of the patient lies with the medical staff and relatives.
Patients need to ensure hygiene, change dirty bedding, clothes on time, provide them with the required amount of moisture-absorbing diapers and proper nutrition.
Good prevention of pressure sores is the frequent and regular change in the patient’s body position (turning over) and light massage.
These measures will help reduce the risk of pressure sores.