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Facts and Pictures About Pressure Sores, Ulcers and Wounds
Sores and Wounds That Won't Heal
Do you have a wound, ulcer or open sore on your leg or foot that
won’t heal or keeps returning? Leg and foot sores, ulcers and
open wounds are a common problem. They may be caused by:
- Poor circulation
- Venous insufficiency (a failure of the valves in the veins
of the leg)
- Lymphedema (a buildup of fluid that causes swelling in the
legs or feet)
- Diabetes
- Pressure (lying in one position for too long)
- Genetics (they may be hereditary)
- A malignancy
- Inflammatory diseases
- Infections
- Certain medications
- Other medical problems
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Overview of Pressure Ulcers and Sores
As defined by the Wound, Ostomy and Continence Nurses Society
(WOCN), the leading professional association specializing in the
management and rehabilitation of persons with wounds, pressure
ulcers are also known as bedsores, pressure sores, and decubitus
ulcers. They are an injury caused by constant pressure to the
skin and muscle. They develop when skin is compressed between a
bone and an external surface, such as a bed or chair. Unrelieved
pressure on skin compresses the blood vessels that supply
nutrients and oxygen to skin and other tissue. This kills the
tissue (tissue necrosis), starting with the tissue closest to
the bone. More than 1 million individuals develop pressure
ulcers annually; there are approximately 1.5 to 3 million adults
currently living with pressure ulcers in the United States. In
acute care settings, pressure ulcers represent a cost of $2.2 to
$3.6 billion annually to the United States health care system.
Despite these reported statistics, the true size of the problem
remains unknown because pressure ulcers are not a reportable
condition in all settings. Consequently, these figures are only
estimates.
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Treating
Pressure Ulcers (Diabetic Ulcers, Decubitus Ulcers, Wounds,
Bedsores and Open Sores)
The primary goal in the treatment of pressure ulcers is to obtain
healing as soon as possible. The faster the healing,
the less chance for an infection. If infection becomes a
problem, the immediate use of an antibacterial (such as
Terrasil Cream) is of great importance.
There are several key factors in the appropriate treatment of
a pressure ulcer:
- Relieve pressure: Use pillows, special foam
cushions, and sheepskin to reduce the pressure.
Avoid further trauma or friction. Powder the sheets lightly
to decrease friction in bed. (There are many items made
specifically for this purpose -- check a medical supplies
store.)
- Control Infection: Infection has one of the
greatest effects on the healing of a wound. Purulent
discharge provides a breeding ground for excess bacteria, a
problem especially in the immuno-compromised patient.
Symptoms of systemic infection include fever, pain, erythema,
edema, and warmth of the area, not to mention purulent
discharge. Additionally, infected wounds may have a
gangrenous smell, be discolored, and may eventually exude
even more pus. In order to eliminate this bio-burden, it
is imperative to apply antiseptics and antimicrobials (such
as Terrasil Skin Cream) at
once. It is not recommended to use hydrogen peroxide for
this task as it is difficult to balance the toxicity of the
wound with this. New dressings have been developed that have
minerals in them, and they are
used to treat bad infections. It is not recommended to use
systemic antibiotics to treat infection of a diabetic ulcer, as it
can lead to bacterial resistance.
- Nutritional Support: Upon admission, the patient
should have a consultation with a dietitian to determine the
best diet to support healing, as a malnourished person does
not have the ability to synthesize enough protein to repair
tissue. The dietitian should conduct a nutritional
assessment that includes a battery of questions and a
physical examination. If the patient is found to be at risk
for malnutrition, it is imperative to begin nutritional
intervention with dietary supplements and nutrients
including, but not limited to, arginine, glutamine, vitamin
A, vitamin B complex, vitamin E, vitamin C, magnesium,
manganese, selenium and zinc. It is very important that
intake of these vitamins and minerals be overseen by a
physician, as many of them can be detrimental in incorrect
dosages.
- Stimulate Wound Healing and Skin Growth with Gentle
Electrical Energy and Oxygen: Several studies have
demonstrated that electrical currents exist in living
organisms. Cells follow the path of the flow of current,
referred to as the galvanotaxis effect. Use of electrical
stimulation (sometime called "e-stim") for the treatment of chronic wounds has
increased in popularity during the last several years. It is
theorized that electrical stimulation augments the
endogenous bioelectric system in the body. The increase in
the rate of wound healing with electrical stimulation is
also theorized to be a result of attraction of different
cell types. The premise for hyperbaric oxygen use is
that increased tissue oxygen in the wound improves and
accelerates resistance to bacteria, collagen synthesis,
angiogenesis, and epithelialization (growth of new skin
cells). An elevation in oxygen also helps heal injuries by
fostering the growth of tiny blood vessels that funnel
in important nutrients and by keeping existing blood
vessels open. Oxygen also helps produce collagen, the
main wound-repairing connective tissue in skin.
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Bedsores and Bedsore Care
Bedsores, more properly known as pressure ulcers or decubitus,
are lesions caused by unrelieved pressure to any part of the
body, especially portions over bony or cartilaginous areas.
Although completely treatable if found early, without medical
attention, bedsores can become life-threatening.
The definitions of the four pressure ulcer stages are revised
periodically by the National Pressure Ulcer Advisory Panel (NPUAP)
in the United States. Briefly, however, they are as follows:
- Stage I is the most superficial, indicated by redness that
does not subside after pressure is relieved. This stage is
visually similar to reactive hyperemia (a technical term for
excessive redness) seen in skin after prolonged application of
pressure. Stage I pressure ulcers can be distinguished from
reactive hyperemia in two ways: a) reactive hyperemia resolves
itself within 3/4 of the time pressure was applied, and b)
reactive hyperemia blanches when pressure is applied, whereas
a Stage I pressure ulcer does not. The skin may be hotter or
cooler than normal, have an odd texture, or perhaps be painful
to the patient. Although easy to identify on a light-skinned
patient, ulcers on darker-skinned individuals may show up as
shades of purple or blue in comparison to lighter skin tones.
- Stage II is damage to the epidermis extending into, but no
deeper than, the dermis. In this stage, the ulcer may be
referred to as a blister or abrasion.
- Stage III involves the full thickness of the skin,
extending into, but not through, the subcutaneous tissue
layer. This layer has a relatively poor blood supply and can
be difficult to heal. At this stage, there may be undermining
that makes the wound much larger than it may seem on the
surface.
- Stage IV pressure ulcer Stage IV is the deepest, extending
into the muscle, tendon or even bone.
Unstageable pressure ulcers are covered with dead cells, or
eschar and wound exudate, so the depth cannot be determined.
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Treatment of Bedsores
(source Wikipedia)
- Relieve pressure: Use pillows, special foam
cushions, and sheepskin to reduce the pressure.
Avoid further trauma or friction. Powder the sheets lightly
to decrease friction in bed. (There are many items made
specifically for this purpose -- check a medical supplies
store.)
- Remove Dead Tissue: The removal of necrotic
tissue by a medical professional is an absolute must in the
treatment of pressure sores. Because dead tissue is an ideal
area for bacteria growth, it has the ability to greatly
compromise wound healing.
- Control Infection: Infection has one of the
greatest effects on the healing of a wound. Purulent
discharge provides a breeding ground for excess bacteria, a
problem especially in the immunocompromised patient.
Symptoms of systemic infection include fever, pain, erythema,
edema, and warmth of the area, not to mention purulent
discharge. Additionally, infected wounds may have a
gangrenous smell, be discolored, and may eventually exude
even more pus. In order to eliminate this bioburden, it
is imperative to apply antiseptics and antimicrobials (such
as Terrasil Skin Cream for Bedsores) at
once. It is not recommended to use hydrogen peroxide for
this task as it is difficult to balance the toxicity of the
wound with this. New dressings have been developed that have
minerals in them, and they are
used to treat bad infections. It is not recommended to use
systemic antibiotics to treat infection of a bedsore, as it
can lead to bacterial resistance.
- Nutritional Support: The patient
should have a consultation with a dietitian to determine the
best diet to support healing, as a malnourished person does
not have the ability to synthesize enough protein to repair
tissue. The dietitian should conduct a nutritional
assessment that includes a battery of questions and a
physical examination. If the patient is found to be at risk
for malnutrition, it is imperative to begin nutritional
intervention with dietary supplements and nutrients
including, but not limited to, arginine, glutamine, vitamin
A, vitamin B complex, vitamin E, vitamin C, magnesium,
manganese, selenium and zinc. It is very important that
intake of these vitamins and minerals be overseen by a
physician, as many of them can be detrimental in incorrect
dosages.
- Stimulate Wound Healing and Skin Growth with Gentle
Electrical Energy and Oxygen: Several studies have
demonstrated that electrical currents exist in living
organisms. Cells follow the path of the flow of current,
referred to as the galvanotaxic effect. Use of electrical
stimulation for the treatment of chronic wounds has
increased in popularity during the last several years. It is
theorized that electrical stimulation augments the
endogenous bioelectric system in the body. The increase in
the rate of wound healing with electrical stimulation is
also theorized to be a result of attraction of different
cell types. The premise for hyperbaric oxygen use is
that increased tissue oxygen in the wound improves and
accelerates resistance to bacteria, collagen synthesis,
angiogenesis, and epithelialization (growth of new skin
cells). An elevation in oxygen also helps heal injuries by
fostering the growth of tiny blood vessels that funnel
in important nutrients and by keeping existing blood
vessels open. Oxygen also helps produce collagen, the
main wound-repairing connective tissue in skin.
back
to top
Diabetic Ulcers and their Care
A skin ulcer is where an area of skin has broken down and you
can see the underlying tissue. Most skin ulcers occur on the
lower legs or feet. The skin normally heals quickly if it is
cut. However, in some people with diabetes the skin on the feet
does not heal so well and is prone to develop an ulcer. This can
be even after a mild injury such as stepping on a small stone in
your bare feet.
Ulcers are healing wounds that develop on the skin, mucous
membranes or eye. Although they have many causes, they are
marked by:
- Loss of integrity of the area
- Secondary infection of the site by bacteria, fungus or
virus
- Generalized weakness of the patient
- Delayed healing
Diabetic foot complications are the most common cause of
nontraumatic lower extremity amputations in the industrialized
world (source American Academy of Family Physicians). The risk
of lower extremity amputation is 15 to 46 times higher in
diabetics than in persons who do not have diabetes mellitus.
Furthermore, foot complications are the most frequent reason for
hospitalization in patients with diabetes, accounting for up to
25 percent of all diabetic admissions in the United States and
Great Britain. The vast majority of diabetic foot complications
resulting in amputation begin with the formation of skin ulcers.
Early detection and appropriate treatment of these ulcers may
prevent up to 85 percent of amputations.
According to the Wound Care Information Network, diabetics
are prone to foot ulcerations due to both neurologic and
vascular complications. Peripheral neuropathy can cause altered
or complete loss of sensation in the foot and/or leg. Similar to
the feeling of a "fat lip" after a dentist's anesthetic
injection, the diabetic with advanced neuropathy looses all
sharp-dull discrimination. Any cuts or trauma to the foot can go
completely unnoticed for days or weeks in a patient with
neuropathy. It's not uncommon to have a patient with neuropathy
tell you that the ulcer "just appeared" when, in fact, the ulcer
has been present for quite some time. There is no known cure for
neuropathy, but strict glucose control has been shown to slow
the progression of the neuropathy.
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A staging system for rating ulcers [developed by National
Pressure Ulcer Advisory Panel (NPUAP)], is designed to rate the
severity of pressure ulcers.
- Stage 1 - There is erythema of intact skin which does not
blanch with pressure. It may be the heralding lesion of skin
ulceration.
- Stage 2 - There is partial skin loss involving the
epidermis, dermis, or both. The ulcer is superficial and
presents as an abrasion, blister, or wound with a shallow
center.
- Stage 3 - This is an entire thickness skin loss. It may
involve damage to or necrosis of subcutaneous tissue that may
extend down to, but not through, the underlying fascia. The
ulcer presents as a deep crater with or without undermining of
adjacent intact tissues.
- Stage 4 - Here there is entire thickness skin loss with
extensive destruction, tissue necrosis, or damage to muscle,
bone, or supporting structures. Tendons, and joints may also
be exposed or involved. There may be undermining and/or sinus
tracts associated with ulcers at this stage.
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Venous Leg Ulcers
Ulcers are breaks in the layers of the skin that fail to heal.
They may be accompanied by inflammation.
Sometimes they don't heal and become chronic. Chronic foot and
leg ulcers mainly affect the elderly.
People with diabetes are at special risk of developing foot
ulcers, and foot care is an important part of diabetes
management.
The most common cause of chronic leg ulcers is poor blood
circulation in the legs. These are known as arterial and venous
leg ulcers. Other causes include:
- injuries - traumatic ulcers
- diabetes - because of poor blood
circulation or loss of sensation (nerve damage) resulting in
pressure ulcers
- certain skin conditions
- vascular diseases (stroke, angina, heart attack)
- tumors
- infections
Venous ulcers are wounds that are thought to occur due to
improper functioning of valves in the veins usually of the legs.
They are the major cause of chronic wounds, occurring in 70% to
90% of chronic wound cases. Venous ulcers have a high prevalence
and are more common in women than in men.
A leg with venous problems has a very characteristic appearance:
- the leg is swollen
- the skin surrounding a venous ulcer is dry, itchy and
sometimes brownish in color
- eczema may appear (varicose eczema)
- the ulcer has a weeping, raw appearance and is usually
painless unless infected
- venous leg ulcers are often located just above the ankle,
typically on the inside of the leg
Most of venous leg ulcers occur because the valves connecting
the superficial and deep veins are not functioning properly. The
venous system is made up of superficial and deep veins:
- superficial veins are located between the skin and the
muscles
- deep veins are located between the muscles
Superficial and deep vein systems are connected to each other by
veins that have one-way valves. These valves normally ensure
that blood flows from the superficial veins to the deep system.
Failure of these valves causes blood to flow from the deep veins
back out to the superficial ones - a major cause of varicose
veins.
Read about treating Venous Leg Ulcers with
Terrasil® Skin Cream
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Arterial Leg Ulcers
Approximately 10 per cent of all leg ulcers are arterial ulcers.
Feet and legs often feel cold and may have a whitish or bluish,
shiny appearance. Arterial leg ulcers can be painful. Pain often
increases when your legs are at rest and elevated. You can
reduce pain by sitting on the edge of the bed with your feet on
the floor. Gravity will then cause more blood to flow into your
legs.
What can trigger or worsen arterial leg ulcers?
- Smoking
- High blood pressure
- Diabetes
- Arthritis (rheumatoid arthritis)
- Old leg ulcers
- Coronary heart disease, including coronary thrombosis
(blood clots in the arteries of the heart)
- Atherosclerosis in the legs.
How are venous and arterial leg ulcers treated?
Treatment depends on the factors that cause the ulcer or have
prevented healing. Once these factors are under control, for
example the blood sugar level in diabetes, the ulcer should heal
by itself. Treatment may involve wound cleansing,
anti-inflammatory treatment and application of dressings (such
as Terrasil® Skin Cream for Ulcers)
to prevent infection.
So long as there is no arterial disease, venous leg ulcers will
benefit from elevation and compression dressings.
Arterial ulcers may benefit from vascular surgery: the insertion
of new leg arteries, for example, or balloon angioplasty - a
procedure that relieves narrowing and obstruction of the
arteries. Sometimes it's necessary to close the ulcer by means
of plastic surgery. This involves taking skin from somewhere
else on your body and placing it over the ulcer. If ulcers are
caused by an underlying disease, it's important this is treated
- for example hardening of the arteries.
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Open Wounds
A wound is an injury that causes either an internal or external
break in body tissue. An open wound (as in a knife cut) is a
break in the skin or mucous membrane. An open wound is at high
risk for infection. Open wound care needs to accomplish three
things: 1) stop dangerous blood loss, 2) prevent infection, and
3) promote healing. Terrasil™
Skin Cream, with Activated Minerals™, has shown to be
effective at both preventing infection and stimulating rapid
healing.
Types of open wounds
Open wounds can be classified into a number of different types,
according to the object that caused the wound. The types of open
wound are:
-
Incisions - caused by a clean, sharp-edged object such as a
knife, a razor or a glass splinter.
-
Lacerations - rough, irregular wounds caused by crushing or
ripping forces.
-
Abrasions (grazes) - a superficial wound in which the topmost
layers of the skin are scraped off, often caused by a sliding
fall onto a rough surface.
-
Puncture wounds - caused by an object puncturing the skin, such
as a nail or needle.
-
Penetration wounds - caused by an object such as a knife
entering the body.
-
Gunshot wounds - caused by a bullet or similar projectile
driving into or through the body. There may be two wounds, one
at the site of entry and one at the site of exit. All stab
wounds and gunshot wounds should be considered major wounds.
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