Wounds and Pressure Ulcers (Bed Sores)

A delay in skin or wound healing can be very frustrating. We want to be able to get back to the things we once enjoyed, or at the very least adapt to everyday life with new ways of coping with our situation. There are various situations that can delay, or otherwise affect, our skin's ability to heal. Let's look at them.

1. Pressure. Very simply, pressure ulcers (sometimes referred to as "bedsores") are caused by pressure. They develop when our body's soft tissue is compressed, over time, between a bony part of our body (such as our ankles, the base of our spine, buttocks, elbows, heels, hips, shoulder blades, etc.), and an external surface (such as a mattress or the seat of our chair, sheets or clothing rubbing against our skin, moisture from perspiration or our own bodily fluids, pressure from our own weight, etc). With prolonged pressure to a certain area, the blood supply to our cells (interchanging our blood's oxygen and carbon dioxide between blood and tissue cells) is disrupted. This prolonged lack of blood supply and oxygen to our tissues may result in a pressure ulcer. People at high risk for the development of pressure ulcers are those people who are unable to move freely. Spinal cord injury patients, stroke victims, and severe or long-lasting injuries may present certain challenges. Factors that can contribute to the development of pressure ulcers include, anemia (a deficiency in the oxygen-carrying component of the blood), poor circulation, diabetes, edema (an accumulation of fluid in tissue spaces), incontinence, malnutrition, mental impairment, and obesity, to name a few.

2. Dryness. Wounds have been found to heal three to five times faster, and less painfully, in a moist (but not wet) environment as opposed to a dry environment. When a wound is continuously exposed to a dry environment (such as the air), our cells are not given the ability to move or reorganize-which is part of the healing process. And if nerve endings are exposed in the wound, we will experience pain due to the irritation.

3. Trauma and Swelling. Interfering with the transportation of oxygen and nutrition from our cells to the wound prolongs the healing process (remember Phases 1-3 above?) . Research shows that healing is slowed, or perhaps even stopped, if there is repeated trauma or deprivation of blood supply from swelling.

4. Infection. If the wound is infected, we must first find out the cause of the infection. A wound infection is present if we can see redness around the wound or the skin around the wound is warm to the touch, if there is thick yellow discharge, a foul odor, a hardening of the skin, and/or a fever. In this case, you should contact your health care provider. At the time of your visit, your provider may take a culture of your wound, and perhaps a blood culture, to better determine what is happening.

5. Incontinence. Incontinence is the inability for one to control the bladder or bowel. This can interfere with the wound's ability to heal. Incontinence needs to be managed appropriately. If not, this could impair the wound healing process. Ask your health care provider about receiving incontinence care as well as special underclothing, bed protection, and skin care products available to help with this situation.

6. Dead tissue. There are two types of dead tissue found in a wound. The first type is called slough. This can be described as moist, loose, stringy dead cells, and appears yellow in color. The second type is called eschar and appears as thick, dry leathery-like tissue, and black in color. Dead tissue interferes with the repair process of our wounds and must be removed (by a qualified practitioner) before healing can take place.

7. Age. Aged skin is more likely to deteriorate then a young person's skin. As we age so does the elasticity in our skin. Did you ever notice how the elastic band in under garment looses its elasticity over time? The repeated stretching and washing takes its toll. So too does our skin. We need to pay closer attention to our eating habits. We need to keep well-nourished (see #9, Nutrition, below). We need to make sure that we do not compromise our immune, circulatory, and respiratory systems. And we need to keep properly hydrated (drinking plenty of fluids) and remain free from diseases.

8. Body type. If you are obese, the ability for your wound to repair itself can be greatly hindered because fatty tissue has a poor blood supply. On the other hand, if you are too thin (emaciated), the lack of oxygen and important nutrients may interfere with your wound's ability to heal.

9. Nutrition. Regardless of our age, nutrition plays a vital role in our healing process. Visual appearance of the patient alone does not determine whether we are maintaining an appropriate diet. For example, are you receiving the appropriate caloric intake? Laboratory values such as protein (essential for the repair of tissue), serum albumin (blood protein level), and hematocrit (the percentage of blood occupied by cells) are indicators that must be assessed and monitored regularly.

10. Vascular insufficiencies. Decreased blood supply to the lower leg can be one cause leading to wounds and/or ulcers developing to our legs and feet. These would include arterial ischemic ulcers, diabetic ulcers, pressure ulcers, and venous stasis ulcers. It is important to have these identified for proper treatment.

11. Suppressed immune system. Either by a disease or medication, suppressing the immune system can delay the healing process.

12. Radiation therapy. Ulcerations or changes in the skin itself can occur after radiation therapy treatment.

13. Chronic diseases. Many chronic diseases impact the wound healing process. Diabetes is one example. In the insulin-dependent diabetic population, chronic wounds generally heal very slowly or perhaps not at all. Insufficient amounts of insulin can delay what's known as granulation tissue formation (the red beefy healthy tissue in the healing wound). In this case, the caregiver and the provider need to monitor serum glucose levels of the diabetic patient. You will also want to monitor the signs and symptoms of infection (see #4 above), as well.

Did you know - poor hygiene leading to infection can cause death?