Bedsores

Stage II-III Bedsores. Surrounding the ulcer is an area of hyperemia which manifested as red skin and also necrotic skin. The necrotic skin must be removed and preventive measure should be continued to avoid larger area of bedsores.

1. Basically a gangrene caused by local pressure. Also known as pressure sore or decubitus ulcer

2. Predisposing factor includes PRESSURE, INJURY, ANAEMIA, MALNUTRITION and MOISTURE.

3. Staging of bedsores

Stage I (Impending ulceration)

- Blanchable erythema due to reactive hyperemia

- Resolve within 24 hours of pressure relieves

Stage II (Partial thickness skin loss)

- Involving epidermis or dermis and represented by abrasion, blister or ulcer

Stage III (Full thickness loss)

- May extend to the subcutaneous tissue but not through underlying fascia

Stage IV (Extension into muscle, bone, tendon or joint capsule

4. Prevention includes

- Foam block

- 2 Hourly turning position

- Ripple mattress bed (air bed)

- Good nursing care to avoid contamination from urine, sweat and faeces. (adhesive film)

- Lotion.

- Early ambulation.

5. Treatment

- PREVENTION is a MUST as treatment is very difficult. once a bedsores occur, it will progress and healing process will take a long time. It is a well known fact that managing bedsores are very COASTLY. Besides, bedsore also increase morbidity and mortality rate among hospitalized patient.

- Treatment based on stage

a) Stage I

            Preventive measures

b) Stage II

            Preventive measures + dressing via simple solution (Normal saline or diluted chlorhexidine)

c) Stage III and above

            Preventive measures PLUS

            Dirty wound: Hydrogen Peroxide + Poviderm + Chlorhexidine

Moderately dirty: Vacuum assisted dressing, specialized wound solution with capacity of promoting granulation

            Clean wound: Normal saline

  

-Based on assesment of the wound,

- Vacuum dressing

- Wound debridement

- Skin flap.

- Correction of underlying anemia, hypoalbuminaemia or any malnutrition.

Stage IV bedsores that involves penetration up to sacral bone.

Large area of bedsore. From inspection, it appears as grade II bedsore. However, careful examination should be conducted as superimposed infection will give rise to a deep pocket underlying the skin. this pocket are need to be thoroughly debride so that the wound management would be effective

A successful wound management will promote formation of granulation tissue. however, such a large defect require skin flap and active preventive measures and continuous nursing care to avoid it from being infected.