A decubitus ulcer, also referred to as a pressure ulcer or bed sore, is a skin lesion caused by constant friction of the skin to a pinpointed area. The friction can come from things such as clothing or the pressure of a body part against a hard surface. The exertion of prolonged pressure against the body causes poor circulation to the tissue. Eventually, the breakdown of skin occurs, causing tissue damage and in worst cases, tissue death.
People who are paralyzed, the elderly, those who have limited mobility or are confined to bed rest have the highest risk of receiving a pressure ulcer. A pressure ulcer will commonly appear on areas of the body that are pointy, such as should blades, back of the head, hips, heels, and tailbone. Although, you can also find pressure sores from catheter tubing against the leg, eyeglasses or even oxygen tubing too tight against the face.
Layers of the Skin
It’s key to understand the layers of skin to understand the stages of pressure sores. The deepest layer is the bone. On top of bone is a layer of muscle. The muscle depth depends on the build of the person. Next, you have subcutaneous fat. Just as with the muscle, the layer of fat varies from person to person. A layer of the dermis finally appears on top of the subcutaneous fat. Topping off the dermis is your epidermis, the thinnest layer of them all.
Stage I of a Pressure Ulcer
Stage I of a pressure sore may be the most difficult to recognize. It does not break the skin. It appears differently in color variation according to skin tone. Noticeable changes to the body may include:
- A persistent redness in lightly pigmented individuals. Darker skin tones appear with a persistent coloration of red, blue or purple hues.
- There is likely to be a difference in temperature. This can either be warmth or coolness of the skin.
- Sensation of the area is heightened causing pain. Severity of the pain will fluctuate with each individual. Stage I pressure sores often persist the sensation to itch the area.
- Tissue consistency will change. Once again, varying from person to person, the tissue will become extremely firm or quite boggy.
Stage II of a Pressure Ulcer
At this point in the process the prolonged pressure has cause a break in the skin. Noticeable changes in the body may include:
- Tissue will show partial loss of the skin involving the epidermis, dermis or both.
- It will be oddly shaped. It may appear as blister or shallow crater.
- Temperature of the skin around the sore will be warmer.
Stage III of a Pressure Ulcer
The ulcer will show substantial damage to the tissue. Noticeable changes include:
- Going a little deeper than Stage II, this stage pressure ulcer shows damage or death to the subcutaneous tissue layer.
- There can be slight damage to the nerves. However, if nerves are undamaged sensation of the area will be extremely painul.
- The shape of this stage appears as a deep crater with or without possible depression of adjacent tissue.
- A clear, yellow, or white liquid may drain from wound.
- Risk of infection is possible.
Stage IV of a Pressure Ulcer
The final stage of pressure ulcers shows extensive damage. Serious complications can result at this stage. Noticeable changes to the area include:
- Destruction of the tissue will exhibit the muscle, tissue necrosis, exposure of the bone and possible damage to the bone. Other possible supporting structures like the tendon or joint capsules may be damaged.
- The wound might drain a white foul smelling liquid.
- Ulcer is prone to infection.
Preventing Pressure Ulcers
Improving overall health is a great way to prevent such sores. Exercising will refine your overall health. This will promote the strengthening of muscles and blood flow throughout the body. Skin should always be clean, dry and smooth. The use of moisturizers may be essential. Frequently change positions to relieve pressure decreases your chance of a pressure ulcer surfacing.
If a pressure ulcer appears, do not lie on the pressure ulcer. Change positions. Arranging a scheduled position change ensures the change occurs. This should be done every two hours if not sooner. Position changes are made possible with pillows or specialized mattresses.
Ultimately, each stage marks a level of severity and the longer they go without treatment the worse off a patient will be.
Source: FamilyDoctor.com, "Pressure Sores" (accessed November 24, 2010)
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