Bedsores - a degenerative tissue changes and necrotizing nature.Pressure sores appear on exposed areas of the body systematic pressure.They also formed as a result of various neurotrophic disorders have lying long enough patients.In these patients create a lasting burden on certain parts of the body, and as a result there is a violation of trophic tissue.In most cases, pressure ulcers occur in the coccyx, sacrum, ischial bone.Much less often they are formed in the joint of the hip, ribs, neck, heels.
Bedsores are also dangerous because if the minimum external skin lesions they can occur intense defeat deeply lying tissues and bones are often in the structure which can be formed deep cavities and pockets.This is often observed in bedsores, are formed in the hip and / or of the ischial bone.Long-existing pressure ulcers are often the reason for the amputation of joint (hip) and / or lower extremity.
Bedsores can be complicated by inflammation of the bone in the form of osteomyelitis
Almost everyone knows that human tissue function in the case when they receive the necessary nutrients from the bloodstream.Blood vessels that amount in millions permeate all human tissue, is presented as a flexible tube, is a kind of "conductors" of blood to all the organs and tissues of the human body.The smallest of the blood vessels called capillaries, which are essential for optimum metabolism in the body.Blood flow in such ducts easy to slow down or even stop by squeezing them.Each sitting or lying person begins to occur compression of blood vessels and, as a consequence, squeezing the soft tissue, which seems to cause a defective blood supply to the tissues.When this state lasts for more than two hours, it begins to develop ischemia and later soft tissue necrosis.Begins its development bedsore.
distinguish endogenous and exogenous bedsore patient.The reasons for the development of pressure ulcers exogenous factor is the role of the strong crush the soft tissues.
Determine internal and external exogenous bedsores.External pressure sores often appear in places where exposed to pressure between the skin and underlying bone is practically no muscle fibers.For example, such sites include: neck, scapula, femoral condyle, the area of the olecranon, the sacrum, and so on. Generally, these pressure sores occur in patients after surgery or after injuries that long forced to be in a certain position, typically supine.The main causes of exogenous pressure sores include: fixed wrong tires or plaster casts, properly fitted dentures, medical devices and orthopedic corsets and tight bandages, folds clothes and sheets.Domestic exogenous bedsores developed under strict catheters or drains that are in the long wound cavity or organ.
Endogenous bedsores appear under intense circulatory disorders and neurotrophic disorders.Determine mixed endogenous neurotrophic and bedsores.Mixed bedsores occur in debilitated patients who can not change the position of a limb or the body.Long immobility leads to ischemia of the skin, disturbance of microcirculation in the protrusions of bone and the development of pressure ulcers.
endogenous neurotrophic bedsores occur in patients with spinal cord injury, major nerves, stroke, brain tumor.Because of nervous disorders begin development of resistant disorders neurotrophic nature of tissue.For the development of pressure ulcers is sufficient neurotrophic weight own skin over the bony prominences.For example, over the rib arcs over the top - anterior iliac spines.
Risk factors in the occurrence of pressure ulcers in a patient are: poor diet and insufficient intake of fluid in the body, overweight or exhaustion, diseases of the cardiovascular system, diabetes, incontinence, trauma and fractures of the back, dirty skin, crumbs and small itemsUnder a lying sick in bed, folds and seams of clothing.
As stated above, pressure sores are formed in areas that have long been subject to prolonged pressure and the process of blood supply in places broken.Separate qualifications bedsores, as a rule, the degree of destruction of soft tissues in depth;so to speak about the state of the affected tissue and their depth.
There are 4 stages of pressure ulcers:
- The first stage is characterized by bedsores seal tissue at the site of the lesion and its erythema, edema can occur.In this step, bedsores very well undergo antibiotic treatment with wound healing drugs.
- The second stage is characterized by the formation of pressure ulcers in the affected areas of erosions and ulcers.But, at this stage, stage still does not occur due tissue damage.Amazed only the top layer of the epidermis.The second stage of therapy is also subject to successfully and well-chosen tactics and held perhaps a persistent improvement in the patient with bedsores.
- The third stage is characterized by a deep bedsores intense diseased tissue that are under the skin.Damage occurs subcutaneous layer, which eventually leads to irreversible necrotic lesions.This stage is extremely difficult amenable to therapy.
- The fourth stage is characterized by the excessive damage and necrotic changes of soft tissues as well as blood circulation in these areas.Such changes can result, ultimately, in severe intoxication, and further whole body blood poisoning (sepsis).
Clinical manifestations of pressure sores in the patient appear on the main backdrop, often very severe disease, depending on the variety of pathogenic organisms and the nature of necrosis.In the first stage of determining moderate local pain and a slight numbness.When traumatic spinal cord areas of necrosis may be formed in a day, and in other cases, the transition to the second stage bedsores process is slower.
With the development of pressure ulcers in the form of dry necrosis of the patient's condition does not change much, because, intoxication is not very pronounced.Mummified affected area demarcation line ends because of dry necrosis does not apply.
Other clinical picture can be observed in the appearance of bedsores as a wet necrosis.From under the necrotic tissue character stands out bad content;as a result of intensive reproduction of pathogenic and putrefactive flora it begins to spread rapidly necrotic process.Formed as a result of gangrene dekubitalnaya provokes purulent resorptive fever and severe intoxication.Determined by the rise in body temperature to 40 ° C, delirium, depression of consciousness, fever, tachycardia, shortness of breath, low blood pressure, an enlarged spleen and liver, and so on. Severe intoxication combined with proteinuria, pyuria, anemia and progressive dysproteinemia.In the blood revealed a significant increase of leukocytes with neutrophilia with a left shift, increased ESR.
Bedsores often lead to complications.The most serious and frequent ones considered sepsis.
Because it is not always possible to determine only on appearance, on what stages of development is the defeat of the skin and tissues, for the correct diagnosis resorting to such methods as the culture method and tissue biopsy from a bedsore.
treatment of pressure ulcers should be based on two main conditions: rapid recovery of optimal blood flow to the affected area of the body;necessary measures for the rapid healing of wound cavities which were formed as a result of pressure sores.
If you change the color of the skin stop all possible pressure on the skin portion of the change in body position;skin treated with alcohol camphor;placed under the patient's inflatable rubber circle;Patient wash with cold water.With the development of the local areas of necrosis therapy is aimed at drying the necrotic tissue and prevent the transition of dry necrosis in the wet.To do this, resorting to the use of 1% solution of potassium permanganate, 0.5% aqueous-alcoholic p-ra chlorhexidine, 1% solution of brilliant green.The area of deep bedsores closed dry antiseptic dressing.At this stage, inadmissible to use ointment and bandages wet.After the rejection of a scab from bedsores and fill it with granulation wound cavity used ointment dressings or produce autodermaplasty indicated.
With deep bedsores that occur in a wet necrosis, the main aim of local therapy is to achieve a rapid rejection of necrotic tissue.Most effective in this respect considered as proteolytic enzymes, particularly protease immobilized with prolonged action and ointments based on hydrophilic (Levomekol, Levosin, Dioksikol).Acceptable use of dressings with hypertonic saline.If necessary, in some cases, perform necrectomy, the application of which significantly reduces the treatment of bedsores.
When gangrene dekubitalnoy and other necrotic complications of surgical treatment is recommended, opening burrowing pus, abscesses and so forth. With further drainage and the therapy according to the methods of treatment of purulent wounds.Apply different methods of plastic closure of defects, which were formed on the skin after excision of necrotic tissue nature and erosive surface bedsores.In order to close the wound tissue used local (rotational plastic flap on the leg, s-shaped plastic and so on.) Or split skin graft autodermaplasty.Skin grafting is also used in large granulating wounds during the final stage of local therapy.Antibiotic therapy must necessarily take into account the sensitivity of pathogenic organisms to it.
addition to local therapy should be carried out intensive quality treatment of the underlying disease, the use of a stimulating and detoxifying therapy.To achieve this, apply a blood transfusion;gemodeza solutions, reopoliglyukina etc .;immunnostimulyatory used, vitamin therapy, prescribed high-energy food.
antiexudative therapy was well achieved by using powder Delaskin.It is considered important to carefully care for bedsores and skin around them.Several times a day is recommended to use local baths Delaskin powder that promotes healing and well-epithelialization bedsores.During hygiene procedures should be carried out with great care rubdown, avoiding strong friction on the skin of the patient.After the hygiene, wound cavity is left to complete samovysyhaniya.It should also be sanctioned by the wet-drying compresses Delaskinom.Therapy was continued for 5-7 days.
antibiotic therapy was initiated two days after the start of the primary treatment.It is recommended to use a cream Fuzikutan.The cream is applied thinly to the affected area 3 bedsores p.per day for 7 days.
For good healing bedsores used drug Vulnostimulin.Its starting to use on the 9th day after the primary therapy for 2 times a day, morning and evening.Therapy is continued until complete healing of bedsores.
With deep bedsores, especially when the damaged area a vast and difficult to heal, produce transplant tissues.
prognosis of exogenous external bedsores usually favorable because after eliminating the pressure on tissues and of adequate therapy fails very quickly achieve a complete cure.More severe bedsores for the treatment considered exogenous internal pressure sores because of the likelihood of damage to the walls of the capillary vessels, hollow organs with the possibility of occurrence of severe complications.When endogenous bedsores prognosis is usually poor, because the patient is substantially complicated by the underlying disease and the occurrence of purulent-necrotic process actually reduces the likelihood of a favorable outcome.
Bedsores treatment at home
Despite the fact that the formation of pressure ulcers is a slow process, to deal with their treatment and prevention is still necessary.For home treatment to the affected area recommended bandaging.This method is considered as a method of protection from pathogenic microorganisms and the way for better absorption ointment to the affected area.Rectangular shape gauze bandage is applied on the skin and secured with hypoallergenic adhesive on its contour, holding healthy skin.Ointment be superimposed in the center of the dressing, not the center of the bedsore.Such therapy may help already within two weeks.
treatment of pressure ulcers in the home is recommended to carry out in the case of slight flushing of the skin, and the first signs of bedsores.Treatment is carried out Tsindol emulsion or zinc ointment.It is also recommended to use a cream Menalind series.It also includes a zinc oxide.After laying a cream or ointment affected area is covered with bandage.As a rule, the development of education stops.
If the damaged area is not skin deep, and formed bedsores up to 2 cm in depth, but there is green, yellow, purple or red and black patina and there is pus, it can be treated in such a vehicle.Take the container and wiped with alcohol.In the three parts of the balm Wisniewski added dioksidina of the 1% solution.Since these two drugs are bad enough connected, you need to carefully mix to a state of uniform consistency.For the therapy of a bedsore composition prepared is applied for 2 days.After this period of time, usually begins healing and new bandage is applied again with the new preparation of the composition.If you replace the dressing every day, the effect of the treatment can not be.In some cases, advised the use of ointments levomikol.But according to the latest results of the use of this ointment it gives little noticeable therapeutic effect.
treatment of pressure ulcers in the home goes well with the use of drugs in the form of ointments and methyluracyl Panthenol ointment, but again, their effect is weaker.
In certain cases, bedsores recommend treating with a solution of potassium permanganate thick.Although potassium permanganate is not conducive to the destruction of microorganisms, but the treated area is rapidly covered with a crust of black necrotic tissue, under which can continue to develop pathogenic microflora.Suppurative process extends into the deeper layers of soft tissue and inflammation may reach the bone.From the wound site can be heard unpleasant putrid odor.Such a state of danger the development of sepsis.
Often, treatment of pressure ulcers in the home spend vserazlichnymi traditional methods and means, for example, the cabbage leaves.But, as practice shows, in this case it is better not to use this method because there assistance can only be a doctor - a surgeon.He excised necrotic crust of dead tissue.After the wound site must be treated with special preparations for the removal of necrotic tissue.
treatment of bedsores
initial care of pressure ulcers need to provide, if the patient has redness and swelling in the places they occur.