Sunday, January 15, 2006

decubiti (pressure sores, bedsores)

Pressure sores are areas of soft tissue breakdown or skin ulceration usually occurring over bony areas, such as hip, heel, shoulder, or elbow, caused by occlusion of the capillary circulation. Since more elderly people have conditions that confine them to wheelchairs or beds, decubiti are a major problem for the incapacitated elderly.
Decubiti are caused by excessive or prolonged pressure produced by the weight of the body or limb. There are four factors that may contribute to their development; pressure, shearing, friction, and moisture. The prevention of a pressure sore is far simpler than treatment or care. Frequent changing of the position of an immobile person, thorough cleansing of the skin, gentle massage of the bony prominences to stimulate circulation, and use of sheepskin, antipressure padding, or water mattresses are all extremely helpful.
Treatment of pressure sores is directed at establishing a clean, moist environment that will encourage regrowth of skin. Another factor for improved healing is treatment of existing medical conditions such as anemia and diabetes mellitus. Topical agents are used to heal the infection. Simple saline dressings have proven to be a superior treatment of pressure sores since they are nontoxic to the tissues. Transparent adhesive dressings may be useful if placed over small, clean ulcers located in areas that are vulnerable to soiling from urine or feces. Physical agents such as infrared and ultraviolet light, ultrasound, hyperbaric oxygen, oxygen, heat lamp, and whirlpool are also used as treatment. Debridement (removal) may be necessary. The debridement may be surgical or chemical.
When all of these methods fail, skin grafting may be considered. This may not be successful, however, since the area of the pressure sore usually has a decreased circulation, causing a large percentage of skin graft rejections.
Treatment and prevention of pressure sores are extremely important because severe infections may develop, which may cause prolonged hospitalization or even death.
Ham, R. Geriatric Medicine Annual-1987. Oradell, N.J.: Medical Economics Co., 1987.

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