Decubitus ulcer


Decubitus ulcer

Description, Causes and Risk Factors:

A chronic ulcer that appears in pressure areas of skin overlying a bony prominence in debilitated patients confined to bed or otherwise immobilized, due to a circulatory defect.

A decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs. These ulcers, as well as other wound types, are classified in stages according to the severity of the wound.

All decubitus ulcers have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering, such as a first-degree burn, to a deep open wound with blackened tissue, as in a third degree burn. This blackened tissue is called eschar.

Decubitus ulcer

The usual mechanism of forming a decubitus ulcer is from pressure. However it can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a decubitus ulcer. These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few. The weight of the person's body presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic formation of decubitus ulcer development.

Risk Factors:

    Use a wheelchair or stay in bed for a long time.

  • Are an older adult.

  • Cannot move certain parts of your body without help because of a spine or brain injury or disease such as multiple sclerosis.

  • Have a disease that affects blood flow, including diabetes or vascular disease.

  • Have Alzheimer's disease or another condition that affects your mental status.

  • Have fragile skin.

  • Have urinary incontinence or bowel incontinence.

  • Do not get enough nutrition (malnourishment).

Symptoms:

Symptoms of a pressure ulcer are:

    Red skin that gets worse over time.

  • The area forms a blister, then an open sore.

Diagnosis:

Your doctor may order the following tests:

    Blood tests to assess your nutritional status and overall health.

  • Tissue cultures to diagnose a bacterial or fungal infection in a wound that doesn't heal with treatment or is already a stage IV wound.

  • Tissue cultures to check for cancerous tissue if it's a chronic, non-healing wound.

Treatment:

The treatment for a decubitus ulcer involves keeping the area clean and removing necrotic (dead) tissue, which can form a breeding ground for infection. There are many procedures and products available for this purpose. The use of antibiotics, when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of necrotic tissue. In some situations amputation may be necessary.

The basic treatment of decubitus ulcers is prevention. Prevention cannot be stressed too strongly. To this end, there are many number of devices designed to protect and prevent the formation of decubitus ulcers. The decision of which device to use is based on the location and severity of the wound. These devices may be a Medicare/Medicaid/Insurance-covered item when medically necessary. Most insurance's will cover any needed device, material, or equipment necessary to prevent and treat decubitus ulcers. Prevention is the most humane and cost effective approach to care.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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