Johane Botha and Juan Vermeulen, intern biokineticists at the Enable Centre, share some advice on managing pressure sores
If you make use of a wheelchair, chances are that you have heard the term “pressure sore” and may have also had one before. Pressure “sores” or ulcers, also called decubitus ulcers or bedsores, are a major concern for individuals with disabilities, especially those who make use of a wheelchair or are on extended periods of bed rest.
Knowing what they are, how they occur as well as treatment and prevention measures is crucial for both the person with a disability and their carer.
The what
A pressure ulcer is an injury to the skin or underlying tissue, usually over a bony part of your body, caused by the shearing force of unrelieved pressure on that area.
The severity may differ from a reddening of the skin in mild cases to deep craters with exposed muscle or bone in the most severe cases. Untreated pressure ulcers can be life-threatening.
The how
Pressure ulcers are caused by large amounts of force applied over a short period or less force applied over longer periods. Just like pressure on a hosepipe will affect the waterflow, this force disrupts the blood supply to the affected area which deprives tissues, such as the skin, of oxygen and nutrients.
Unsurprisingly, the most common areas for pressure ulcers to form are the sacrum and buttock bone (ischial tuberosity), heels and the bony parts of your ankle (lateral malleoli).
Elderly people are usually at a higher risk with 70 percent of pressure ulcers occurring in persons over the age of 65. However, people with neurological impairments are also at risk, particularly those with reduced sensation.
Other risk factors include, but are not limited to, increased body temperature, limited mobility, poor nutrition, friction, shear, moisture, general health status and anti-cancer drugs.
The treatment
If a pressure ulcer does develop, you should consult your doctor as soon as possible. Treatments include offloading strategies, management of infections and maintaining a moist environment to promote wound healing. In severe cases, surgery may be necessary to remove dead tissue and transplant healthy skin.
The prevention
Prevention is better than cure and the best approach when it comes to dealing with pressure ulcers. It is difficult to imagine anything worse than lying on your stomach for six months while waiting for an ulcer to heal.
A repositioning schedule is one of the most important tools in your toolbox. How often you reposition yourself is determined by tissue tolerance, level of activity and mobility, general condition, skin condition and comfort.
Repositioning should be done as often as possible, avoiding extended periods in the same position.
The following are some practical measures to help prevent pressure ulcers:
- Use pressure-reducing surfaces like air, gel or water mattresses and/or cushions.
- Replace wheelchair cushions roughly every three years.
- Have a wheelchair fitting and seating done by a professional.
- Do “pressure relief” lifts.
- Avoid a slouched position that puts pressure on the lower back and tailbone.
- Stay hydrated.
- Clean skin following incontinence.
- Apply skin moisturiser to dry skin.
- Consider using silk fabrics as opposed to cotton or cotton blend fabrics – this will help reduce shear and friction on the skin.
- Do not massage or vigorously rub skin in areas prone to developing pressure sores.
- Get assistance to regularly check body areas that you cannot see.
Pressure ulcers can be serious but taking the right preventative steps as part of a daily routine, just like brushing your teeth, can help you protect your mobility and maintain a high quality of life.