Decubitus ulcers are wounds caused by pressure on the skin because the position of the body has not changed for a long time. Sores will appear on areas of the skin that are under the most pressure, such as the heels, elbows, hips, and tailbone. Decubitus ulcers are also known as bed sores .
Decubitus ulcers are at risk for people whose condition causes limited body movements. The sufferer will lie in bed or sit in a wheelchair for a long time so that there are parts of the body that are constantly under pressure.
The above conditions cause blood flow to the tissues in that part of the body to be disrupted. As a result, the tissue dies over time and forms a wound.
Causes of Decubitus Ulcers
Decubitus ulcers are caused by pressure and friction on the skin which can inhibit blood flow to the skin and damage the skin surface. In addition, there are several factors that can also increase a person's risk of developing decubitus ulcers, including:
Decreased sense of taste
Patients who are immobile due to spinal cord injury or nerve disorders usually also experience numbness or decreased ability to feel.
The above conditions prevent the patient from feeling pain or discomfort in the skin due to constant pressure, including when a wound is formed.
Inadequate intake of fluids and nutrients
Patients who cannot move and only lie down are at higher risk of experiencing malnutrition and dehydration. This condition can interfere with the resistance and health of skin tissue, making the skin more vulnerable to damage.
Blood flow disorder
Impaired blood flow due to diabetes, heart disease , kidney failure, or multiple sclerosis or due to lack of movement of the body itself, can increase the risk of tissue damage as a result. This can occur due to a lack of oxygen and nutrient supply to the area.
Apart from the factors above, urinary and fecal incontinence, obesity, and age over 70 years can also put a person at greater risk of developing decubitus ulcers.
Decubitus Ulcer Symptoms
Decubitus ulcers can appear on any part of the body that has been under pressure for a long time. Usually, the area that most often experiences decubitus ulcers is the part of the body that is protruding from the bone.
In wheelchair users, decubitus ulcers will usually appear in the area of the buttocks, coccyx or lower back, spine, scapula, back of the arms, and legs that are leaning on the wheelchair.
Meanwhile, in people who only lie in bed, wounds will usually form on the back and sides of the head, shoulder blades, hips, coccyx, heels, ankles, and the back of the knees.
Based on the level of severity, the following are characteristics of the wounds that appear in people with decubitus ulcers:
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Grade 1
Decubitus ulcers grade 1 are characterized by discoloration of certain areas of the skin, for example, becoming reddish or bluish, accompanied by pain or itching in the area. -
Grade 2
Decubitus ulcers grade 2 are characterized by abrasions or open sores in the affected area. -
Grade 3
In grade 3 decubitus ulcers, there are open sores up to several deeper layers of skin ( skin ulcers ). -
Grade 4
Ulcer decubitus degree 4 is characterized by open sores that are very deep to reach the muscles and bones.
When to see a doctor
Someone who is immobile for a long time, whether in bed or in a wheelchair, needs to be checked regularly by a family member or caregiver. This is important so that decubitus ulcers can be detected as early as possible.
If decubitus sores of any degree are found, consult a doctor immediately . Doctors and the medical team will treat wounds , as well as teach family members and carers how to care for wounds.
During wound care at home, immediately go back to the doctor if signs of infection appear in the form of:
- Fever
- Swelling or discharge of pus in the wound area
Diagnosis of Decubitus Ulcer
In the early stages of diagnosis, the doctor will examine the parts of the patient's body that are prone to developing decubitus ulcers. If a decubitus ulcer is found, the doctor will determine the severity of the wound and provide appropriate treatment.
If necessary, the doctor can carry out supporting examinations, such as a blood test, to find out the general condition of the patient, as well as detect other diseases that the patient may be suffering from.
Decubitus Ulcer Treatment
The following are steps that can be taken to treat decubitus ulcers:
Treatment of decubitus ulcers
If the wound is not open, clean the skin area with soap that does not contain alcohol and fragrance, then dry it immediately. If an open wound appears, the decubitus ulcer needs to be cleaned with an antiseptic and covered with a bandage, so that the wound does not become infected and the skin around it remains dry.
Change the bandage regularly, and clean the wound with physiological saline (saline infusion) every time you change the bandage.
Surgery to remove dead tissue
In order for decubitus ulcers to heal quickly, the scabs and dead tissue need to be removed through minor surgery, without prior general anesthesia. This action aims to stimulate the growth of healthy new skin.
If necessary, the surgeon will use skin tissue from other parts of the body to close the decubitus ulcer.
Negative pressure therapy f
To accelerate wound healing, doctors may also suggest negative pressure therapy or vacuum assisted closure (VAC). This method aims to suck up excess fluid from the wound, reduce the risk of infection, and increase blood flow to the wound so that it can speed up healing.
Change in body position
The body position of decubitus ulcer sufferers needs to be changed periodically. If the patient uses a wheelchair, shift the body weight to the other side every 15 minutes or change positions every hour. If the patient is in bed, change his position to the left, side, right, and lie back every 2 hours.
The doctor will also recommend using an anti-decubitus mattress. This mattress can reduce pressure on certain areas of the skin and keep airflow to those areas good. Even so, the patient's position still needs to be changed periodically.
Drugs
In treating decubitus ulcers, doctors also usually provide drugs, such as:
- Ibuprofen or diclofenac to relieve pain, especially when the patient is being treated for a wound or needs to be changed in position.
- Antibiotics to drink or ointment to fight bacterial infections, if decubitus ulcers have resulted in infection in sufferers.
In addition to the above treatments, sufferers also need to fulfill their nutritional intake, especially protein, vitamins A, C, and E, and drink enough water to speed up the skin healing process. Drinking enough water can help prevent dehydration which can slow down the wound healing process.
Decubitus Ulcer Complications
There are several complications that can arise if decubitus ulcers are not treated immediately, namely:
- Cellulitis , due to infection of the skin and soft tissue
- Bone and joint infections, due to spread of infection from the skin and soft tissues
- Sepsis , which is an infection that spreads to the bloodstream and causes a reaction of the immune system throughout the body that can be fatal
- Cancer, due to wounds that don't heal (Marjolin's ulcer).
Prevention of Decubitus Ulcers
Decubitus ulcers are caused by pressure on the skin over a long period of time. This condition can be prevented by changing body position periodically to reduce constant pressure on certain areas of the body.
If you suffer from a disease that is at risk of causing decubitus ulcers, make sure your body gets adequate nutrition and fluids, and manage stress properly to prevent the appearance of decubitus sores or bed sores .
In addition, using an anti-decubitus mattress and applying lotion to the skin regularly to keep the skin moisturised can also help prevent decubitus ulcers.