How does a pressure sore develop?

Pressure sores develop when the same skin area is pressed on over a prolonged period of time. The pressure obstructs blood flow, causing the skin to break down from the lack of oxygen and nutrients and eventually forming a sore.

Pressure sores can affect any part of the body but they usually develop on bony body parts such as shoulder blades, hips, tailbones, spines, elbows, heels, and ankles.

A person who is bed-ridden or uses a wheelchair for long hours always puts pressure on the same areas. The inability to move and change positions independently and regularly reduces blood flow to affected areas, encouraging the development of pressure sores.
Furthermore, wounds may also worsen when bedsheets or clothes rub against affected areas or if patients are roughly handled on the bed or wheelchair.  

Symptoms

Pressure sores develop in stages and worsen if the affected areas are not cared for or treated properly.
Stage 1: The affected area has a reddened skin tone and does not lose its colour (become lighter colour) when pressure is applied. Skin temperature is usually warmer and can either feel firmer or softer than the surrounding areas.

Stage 2: Skin breaks open to leave an open wound, a pus-filled blister may also be observed. The affected area feels warm and is painful for the patient.

Stage 3: The sore digs deeper, reaching the fat tissue beneath the skin. At stage 3, the wound looks like a small crater.

Stage 4: Pressure sores may no longer feel pain due to extensive tissue damage. The wound reaches deeper tissues such as muscles, tendons, and bones.

How to care for pressure sores?

Stages 1 and 2 sores will heal easily if cared for and treated properly.

• Using air or water mattresses and cushions to relieve pressure, allowing smoother blood flow. Consult your doctor on the types of mattresses and cushions that will be best suited for the patient’s condition.
• Avoid using donut-shaped cushions as it adds more pressure on the surrounding areas and reduces blood flow to the affected area
• Changing positions frequently can help to relieve pressure on affected areas. Caregivers can design a timetable to keep track of this. Patients using a wheelchair should change positions every 15 minutes while bed-ridden patients should move about every 2 hours.
• The skin should be kept clean and dry after bath
• Use recommended moisturizers to moisturize affected skin
• Pressure sores should not be massaged as rubbing on it will encourage the skin to breakdown further

Open wound sores should be cleansed with saline water.

Stages 3 and 4 sores are more complicated as they affect deeper layers of tissue. Recovery may take months to years.

• Patients should contact their doctor immediately if pressure sores are in these stages
• Requires professional care by clinicians
• Wounds will require dressing
• Prescription of antibiotics to treat the infection
• Procedures to remove damaged tissue