Pressure ulcers, also called bedsores, are painful skin ulcers that are formed when constant pressure exerted on any part of the body (usually from a bed or a wheelchair) inhibits circulation of blood in the area. Without adequate blood flow, tissue on that part of the body "dies". It first appears as reddened or darkened skin, followed by the appearance of an abrasion, blister, or shallow ulcer, which ultimately will affect underlying tissue, bone, and joint. As little as two hours of sustained pressure can trigger damage on human skin.

Although paralyzed people are especially at risk, anyone who is bedridden in a wheelchair and cannot change positions on his own can develop pressure sores. These include anyone who is immobilized by acute illness, injury or sedation. Other factors that increase the risk of developing pressure sores are age, residence in a nursing home, lack of pain perception (diabetes, spinal cord injuries, nerve disease), malnutrition, incontinence, and smoking.

Complications/Mortality Impact

If left untreated, conditions like cellulitis (acute tissue infection), bone and joint infection, necrotizing fasciitis (which, without treatment, can cause death in as little as 12-24 hours), gas gangrene (or myonecrosis, a rare and severe form of gangrene caused by clostridium bacteria responsible for toxins that completely destroy affected tissue, eventually causing death), sepsis (bacteria from an infected area enter the bloodstream and spread throughout the body, causing shock and organ failure) may develop.

Prevention

Prevention should include a plan that caregivers can easily follow. Changing positions frequently is crucial to preventing pressure sores. In a wheelchair, shifting every 15 minutes is necessary, while in bed ridden patients, every 2 hours will suffice. Avoid lying directly on the hipbone, legs must be properly supported, and knees and ankles should not touch. Raising the head of the bed more than 30° makes it more likely for the patient to slide down, which can cause friction blisters or shearing injuries. Support using foam wedges or pillows under hips and shoulders to maintain alignment is also helpful.

For those in a wheelchair, the use of pressure release wheelchairs, or if using an ordinary wheelchair, doing wheelchair pushups (Raise the body off the seat by pushing against the arms of the chair) can help. Daily skin inspection and proper nutrition help maintain a healthy skin and protect against skin breakdown and accelerating in wound healing.

Lifestyle changes including quitting smoking (which decreases oxygen to the skin), and daily exercise (which improves circulation and builds vital muscle tissue)are also helpful.