When we sit for sustained periods of time, with constant pressure on one spot, that can’t be good right?! The short and definitive answer is NO….. it’s not good. As you will shortly find out, Movement is medicine.
What is a pressure sore? A Pressure sore is damage to the skin and the underlying tissue when an area of the skin is placed under constant pressure for sustained periods of time. This causes a stop of oxygen and nutrients to the tissue, causing eventual tissue necrosis (death of tissue). Pressure sores often develop by constant pressure or friction mostly to anyone with reduced mobility or inability to change positions such as people who are confined to a bed or wheelchair. The common sites for pressure sores occur over bony areas such as the bottom, heels, elbows, the back of the head and coccyx (tail bone).
How does a pressure sore occur? There are many factors that can cause pressure sores, however, the most common development is through tissue ischemia. Tissue ischemia is a reduction in blood flow to an area, which results in decreased oxygen and nutrition supplies to the tissue. Tissues are capable of sustaining pressure for small periods of time, when the pressure increases too much for too long it can cause blockages which prevent oxygen and nutrition from reaching the tissue.
Another way pressure sores can occur is through friction between the skin and an external support such as a bed or wheelchair. This friction can cause the blood vessels to change their usual shape, reducing the ability for blood to pass through them. The final way pressure sores can develop is through shear force, this is when two surfaces move in opposite directions. An example of this would be when the bed is elevated and you slide down the bed, as your bottom moves down, the skin over the bone might stay in place-pulling in the opposite direction. Different levels of severity Pressure sores are categorised into four stages. Grade 1- Skin becomes discoloured-typically develops red, blue, purple or black. Grade 2- Some skin loss or damage involving the upper most layer of the skin Grade 3- Skin necrosis (death) or damage to the skin Grade 4- Skin necrosis (death) or damage to the skin and underlying tendon, joint or bone.
Why is it important to treat a pressure sore when you notice it? Untreated pressure sores can lead to secondary conditions such as: - Sepsis (bacterial infection in blood stream) - Bone and joint infection - Cellulitis (infection of the skin and connected soft tissues) - Cancer (long term non-healing wounds can develop into a type of squamous cell carcinoma) How can pressure sores be prevented? Develop a plan with your carer that includes changing body position, regular skin checks for pressure sores and daily skin care. Exercise can promote systemic (whole body) blood flow. Certain exercise equipment can allow you to perform exercise in different (pressure reliving) positions, such as; standing, kneeling, lying or crawling. Ensure you or your carer can relieve the pressure and reduce the time that pressure is placed upon the skin, this can be done by shifting your weight frequently. Also adding cushions to your wheelchair may help in providing pressure relief by evenly distributing the pressure. Treatment - Remove the factor causing pressure. - Cleaning the skin depending on the grade of pressure sore. - Damaged tissue can be removed through surgical means if advised by a medical practitioner. - Apply dressings- this protects the wound and assist in healing. References -Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 48(1), 4–16. https://doi.org/10.4103/0970-0358.155260 -Ferguson-Pell, M., Wilkie, I., Reswick, J. et al. Pressure sore prevention for the wheelchair-bound spinal injury patient. Spinal Cord 18, 42–51 (1980). https://doi.org/10.1038/sc.1980.7 -N. C. Petersen & Sven Bittmann (1971) The Epidemiology of Pressure Sores, Scandinavian Journal of Plastic and Reconstructive Surgery, 5:1, 62-66, DOI: 10.3109/02844317109042939 -Wall J. Preventing pressure sores among wheelchair users. Professional Nurse (London, England). 2000 Feb;15(5):321-324. Image references- https://www.medicalnewstoday.com/articles/173972 https://www.everydayhealth.com/multiple-sclerosis/symptoms/pressure-sores-serious-complication -ms-disability/