Decubitus: causes, diagnosis, treatment

A pressure ulcer is a nutritional disorder of the skin and subcutaneous tissue. It is caused by long-term pressure and compression of blood vessels. It can eventually lead to skin death and infection. Bedridden people are often affected, but there are other causes as well.

Causes of bedsores 

The most common occurrence of decubitus ulcers is when the patient is confined to bed. There is a risk of bedsores above all in parts of the body where there is little or no muscle between the skin and the underlying bone. The main ones to mention are:

• Verses
• ankle
• iliac crests
• coccyx
• back of head
• pelvic vanes

Ultimately, however, a decubitus can occur in all places. A bedsore can also occur under poorly fitting dentures or plaster casts that are too tight.

Important factors in the development of a decubitus 

Three factors play a decisive role in the development of decubitus:

1. print
2. time (pressure dwell time)
3. Disposition (risk factors)

The skin is only damaged if there is a certain pressure over a longer period of time (two hours) with an existing disposition of the patient. A factor by itself does not lead to decubitus.

1st pressure

The blood flow in the skin capillaries, the finest blood vessels that ensure the supply of oxygen and nutrients to the individual organs, is impeded as soon as the pressure on the capillaries exceeds a certain level. Pressure on the skin can be applied externally or internally:

• External pressure: For example  , folds  in the bed sheet, unpadded positioning splints, crumbs in the bed, but also catheters and probes if they are under the patient.
• Pressure from within: From bones that lie directly under the skin without muscle or fat pads.

2nd time

The decisive factor is how long the pressure is on certain areas of the skin. If the skin cells’ nutrition has been interrupted for less than two hours, they can recover. If there is a prolonged lack of oxygen, individual cells die and necrosis (tissue death) develops.

3. Disposition

For example, the skin is damaged by:

• Fever :  Sweating  dehydrates the body and increases oxygen consumption
• Moisture: Moist skin softens and is therefore more vulnerable
• Incontinence : In incontinent patients, the skin is not only stressed by moisture, but also by the acidic pH value of the urine and possibly by bacterial contamination (intestinal bacteria).
• Overweight: Overweight patients usually sweat more, and at the same time the weight on the skin is greater
• Shear forces: The “inclined plane” when sitting incorrectly pulls on the skin

The skin is poorly supplied with blood in the case of:

• Anemia  and  cardiac insufficiency , which promote poor blood circulation
• Diabetes  mellitus: here, in addition to the blood circulation, the cell metabolism is also disturbed

Risk factors for pressure ulcers

Pressure relief is hampered by lack of exercise (immobility), being confined to bed (e.g. unconsciousness), paralysis such as hemiplegia and by therapeutic immobilization (cast). Other risk factors include:

• Weakness of the body’s defenses due to inadequate nutrition (e.g. lack of  protein ,  zinc  or  vitamin C )
• bad general condition
• cachexia (wasting)
• chronic diseases that lead to dehydration and atrophy of the skin

Course of a decubitus

There are four degrees of severity of the decubitus:

1. In the case of a first-degree decubitus, only a circumscribed reddening of the skin can be seen.
2. In the second degree, a skin defect has already occurred.
3. A grade 3 pressure ulcer is a deep defect in the skin where muscles, tendons, and ligaments are visible.
4. In the worst form, a defect occurs with bone involvement.

Complications of a decubitus

Infection of the wound can also be an aggravating factor. If the tissue dies, it must be surgically removed.

Treatment of a decubitus

If a decubitus needs to be treated, it is usually too late. Prevention is very important so that pressure ulcers do not develop in the first place. Especially in bedridden patients, the skin should be well cared for. Rubbing with circulation-promoting ointments and massaging the endangered areas can prevent decubitus from the outset. In addition, care should be taken to ensure that the bed is soft, possibly on special mattresses.

Good care also includes repositioning the patient every two hours. A positioning plan is followed: supine position, right side position, possibly prone position, left side position, supine position, etc. At the first signs of decubitus (reddening of the skin), good skin care is the appropriate therapy.

Open wounds must be carefully cleaned. Anti-inflammatory and healing ointments are applied to the wound surface. If there is no improvement in the symptoms after three to four days, the medication should be changed. If the skin and surrounding tissue has already died, it must be surgically removed.