by Aletha Tippett MD
By the WoundSource Editors
Decubitus ulcers are an open skin wound sometimes known as a pressure ulcer, bed sore, or pressure sore. A decubitus ulcer forms where the pressure from body the body's weight presses the skin against a firm surface, such as a bed or wheelchair. Pressure cuts off the blood supply to the skin and injures tissue cells. Initially, the skin usually looks red or a bit discolored. Eventually, if the pressure isn't relieved, the skin breaks down and the tissue dies (necrosis). With proper diagnostic care and treatment, most people with a decubitus ulcer have a good prognosis for recovery.
Where a Decubitus Ulcer Forms
The pressure causing decubitus ulcer formation doesn't have to be very intense. Generally, pressure ulcers develop on skin that covers bony areas of the body like:
- Buttocks and hip area
- Back and shoulder blades
- Ankles, elbows and heel
Who is at Risk for a Decubitus Ulcer?
Individuals with limited mobility and who remain for long periods of time sitting or lying in the same position are vulnerable to developing pressure ulcers. Older individuals with more fragile skin are also at risk. Other risk factors include:
- Poor diet with insufficient nutrients for skin health.
- Not drinking enough water to hydrate skin.
- Medical conditions such as diabetes which causes poor blood circulation to skin tissue.
Signs of Decubitus Ulcer Development
Caregivers of people who are at risk for a decubitus ulcer should regularly check vulnerable skin areas. Signs to look for are:
- Discoloration of the skin
- Areas of open skin
- Infection and signs of hot or red skin
- Pain in the pressure area
- Skin that won't lighten when touched (non-blanchable erythema)
- Skin areas that are of a different texture (softer or firmer) than the skin around it
Stages of Decubitus Ulcers
The National Pressure Ulcer Advisory Panel has developed a series of four stages of a decubitus ulcer to aid in diagnosis and treatment.
Stage I: The skin is discolored but not broken. Light-complexioned people may have red marks. Dark complexioned people may have a discoloration that is blue or purple. In some people, the discoloration is white.
Stage II: Skin breaks open and the ulcer is shallow with a reddish or pinkish wound bed. There may be tissue death around the wound, or a fluid-filled blister.
Stage III: Ulcer on the skin is deeper, affecting the fat layer and looking like a crater. Pus may be in the wound.
Stage IV: Ulcer moves to deeper layers of muscle or bone. A dark material called "eschar" may be inside the ulcer.
Unstageable: An ulcer that is yellow or green. It might have a brown scab covering it, or be soft and look pus filled. A dry and stable ulcer surface is the body's natural protection and should be allowed to continue healing. However, if extensive tissue damage is evident, the covering might need to be removed for treatment.
Diagnosis of a Decubitus Ulcer
Wound care physicians and nurses experienced in pressure ulcers are often consulted for decubitus ulcer diagnosis. Medical personnel may take samples of the pressure ulcer tissue and fluid to look for bacteria or cancer. They may also do blood cultures, bone scans or other tests depending on the seriousness of the ulcer. In addition, they will evaluate the condition of the ulcer according to:
- The size of the decubitus ulcer and depth of the crater
- What kind of tissue is affected by the ulcer: skin, bone, or muscle
- The color of the ulcer and skin around it
- The tissue death caused by the ulcer
- The presence of infection, bleeding or foul odor
Treatment of Decubitus Ulcers
Depending on the stage of the ulcer, treatment can include some or all of the following:
- Cleaning the ulcer and putting a dressing on the wound
- Meticulous wound care with frequent dressing changes
- Reducing pressure on the area by repositioning and using supporting surfaces
- Antibacterial drugs to treat infection
- Pain medications to relieve discomfort
- Debridement surgery to remove dead tissue from the ulcer
- Diet changes and increased fluid intake for faster recovery
Prevention of a Decubitus Ulcer
At risk individuals should be checked for signs of the development of a decubitus ulcer every day. Caregivers need to examine the person's body from head to toe, paying particular attention to bony areas where decubitus ulcers tend to develop. They should look for areas of skin that don't turn white when pressed. Other preventative measures include:
- Changing the person's position every two hours
- Using supporting items like pillows or foam pads reduce pressure over pressure points
- Keeping skin clean and dry and applying moisturizing lotions made especially for fragile skin
- Providing the person will well-balanced, nutritious meals and 8-10 glasses of water daily
- Helping the person do daily range-of-motion exercising
- Cleaning carefully after urination or bowel movement and applying cream formulated for fragile skin if necessary