What are pressure sores?

Pressure ulcers are a loss in the continuity of the skin produced when a pressure maintained on a bone plane or prominence causes a blockage of the blood supply at that level, with a decrease in oxygen and tissue degeneration.

They are more frequent as age advances, due to increased frailty and immobility in older people, but not exclusive to the elderly, since they can also appear in younger people with serious or disabling chronic diseases (spinal cord injuries or patients intensive care units, for example). However, and given its frequency of appearance in the geriatric age and the prognostic importance in this age group, it has come to be considered a geriatric syndrome.

It is considered that 95% of pressure ulcers are preventable, using simple techniques such as postural changes and exquisite care of the skin and the general condition of the patient. tea. Once the ulcer appears, its healing can be long and cause significant morbidity, and a very significant expenditure of health resources.

The location of pressure injuries depends on the posture of the patient and the direction of the pressure and shear forces that cause blockage of capillaries in the area. In supine position (face up) the most frequent areas of involvement are the sacrum and gluteal area, heels, elbows, scapulae, shoulders and occiput; in lateral decubitus they are the trochanters (hips), the knees (both external and internal), the shoulder and the auricle, in order of frequency. But in general, this type of injury can appear anywhere in the body that receives significant pressure for long enough for ischemia to cause tissue damage.

It is considered that the fact of remaining immobile in the supine position, absolutely immobile for a period of more than 3 hours or sitting for more than 2 hours, in a frail patient with risk factors, can cause the appearance of pressure ulcers.

This type of ulcer is classified, for the purposes of evaluation of treatment and prognosis, in 4 grades:

• Grade I: Limited to the superficial layers of the skin, it manifests itself through redness, the skin barrier is not broken and the integrity of the skin is maintained.
• Grade II: It affects the superficial layers of the skin and extends to the first portion of the underlying fatty tissue and manifests as erosions, blisters and / or superficial tears.
• Grade III: It extends deeper through superficial structures, affects the subcutaneous fat, producing necrosis of the compromised tissue and reaches the muscles but without compromising them.
• Grade IV: Destruction of all soft tissue from skin to bone; the level of ulceration reaches muscle, bone, joints, adjacent organic cavities and supporting structures.

As the injury increases in depth, the time it takes to heal increases.

Complications of this type of injury can be:

• Infection of adjacent and distant tissues.
• Loss of protein.
• Anemia due to chronic disease (use of nutrients to try to close the wound by the individual's body).
• Loss of fluids and mineral salts, due to exudate, which in extreme situations can cause dehydration.
• pain due to the involvement of nerve endings and other deep structures.
• Psychological and social affectation due to isolation in case of bad odor due to the destruction of tissues and secondary infection.