Pressure sores (also known as "skin breakdowns" or "decubitus ulcers") can be a very serious, even life-threatening condition. A pressure sore is any redness or break in the skin caused by too much pressure on your skin for too long a period of time. The pressure prevents blood from getting to your skin so the skin dies. Normally the nerves send messages of pain or feelings of discomfort to your brain to let you know that you need to change position, but damage to your spinal cord keeps these messages from reaching your brain.

Individuals susceptible to pressure sores may need to learn new ways to change their position to prevent too much pressure. Pressure sores can occur, for example, if an individual sits or lies in one position too long. Shearing is also a kind of pressure injury. It happens when the skin moves one way and the bone underneath it moves another way. An example of this is slouching when you sit.

Another type of injury, an abrasion, can occur when pulling yourself across a surface instead of lifting. This is an example of a friction injury. In addition, short exposure to high pressure, such as a bump or fall, may cause damage to the skin which may not show up right away.

STAGE ONE:

Skin is not broken but is red or discolored. The redness or change in color does not fade within 30 minutes after pressure is removed.

STAGE TWO:

The epidermis or topmost layer of the skin is broken, creating a shallow open sore. Drainage may or may not be present.

 

Stage three:

The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in stage 2.

 

Stage four:

The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.

 

Preventative measures to help prevent pressure sores

• Make sure your wheelchair foot pedals are adjusted to the right height

• Use a properly adjusted seat cushion that fits both you and your chair

• Do a pressure relief (20 seconds) at least every 20 minutes while you are sitting

• Sit up straight in wheelchair - slumping or slouching leads quickly to early skin breakdown over tailbone

• Sleep on a mattress that offers support, protect pressure areas with soft pillows or sheepskin, and change position regularly while you sleep

• Keep your skin clean and dry

• Eat a well balanced diet that includes foods that are high in protein, vitamins, and minerals

• Drink between 8 and 10 8-ounce glasses of water per day

• Avoid all movements or activities that may rub or cut your skin

• Wear loose clothes, shoes and avoid pants with thick seams, buttons, or zippers

• Check feet carefully when wearing new shoes - shoes should not be too tight or too large.

• Apply support hose and Ace wrap evenly so that they don't wrinkle and cause extra pressure.

• Lie prone to keep hips stretched out. This position spreads pressure more evenly and there is less chance to get sores

• Stick to your turning schedule

• Use lubricating cream if you have dry skin

• Remember: even tiny shifts of position help somewhat

• Check your skin twice a day to look for a red spot and test for warm skin 

• If you have redness that does not go away within 30 minutes after you take the weight off of the pressure area, call your doctor as soon as possible

Do NOT:

• Use a rubber air ring or any kind of doughnut - they create a lot of pressure where you don't want it, and block the flow of blood to skin inside the ring

• Wear sanitary belts - they can lead to pressure sores

• Wear clothing with heavy seams, nylon underwear or tight clothing

• Put articles in pants pockets or on seat of wheelchair

• Use alcohol on dry skin

• Smoke

• Sit in bed with the head raised for long periods - this causes skin to be squeezed over the lower end of the spine and can lead to sores

• Sore becomes smaller.

• Pinkish tissue starts to form along edges of sore and moves toward the center; you may notice either smooth or bumpy surfaces of new tissue.

• Some bleeding may be present - this shows that there is good blood circulation to the area, which helps healing.

• Increase in the size or drainage of the sore

• Increased redness around the sore or black areas starting to form

• Odor and/or the drainage becomes a greenish color

• Fever

• Can be life threatening

• Infection can spread to the blood, heart, bone

• Amputations

• Prolonged bed rest

• Autonomic dysreflexia