Dear Readers

Pearl L, 58, resides in Portmore. She is the caregiver to her 86-year-old mother who is diabetic, hypertensive and has had a leg amputated due to poor circulation, after gangrene set in. Her mother is very inactive and does not walk, spending much of the day in bed. Ms L recently noticed that areas over her mothers buttocks and hips have become sore and an ulcer has developed on one hip. Ms L has obtained dressing from her physician but asks Lifeline for guidance on how to treat bedsores.

Caused by pressure

Bedsores or decubitus ulcers are pressure sores. They are the end result of persistent pressure placed on the skin which covers prominent bony or cartilage structures. For example, the skin over the hips or coccyx (tail bone) or over the heel of the feet. The pressure on the area when the person is immobile for many hours, restricts the blood flow to the area for an extended period of time, resulting in a lack of oxygen and nutrients to the area.

The affected skin initially becomes red, then swelling or hardening of the skin occurs after some days. If this pressure persists the skin eventually cracks and the area becomes painful and even infected, eventually it breaks down into an ulcer. People who are confined to beds and wheelchairs are at an increased risk of developing pressure sores. Diabetes and hypertension sufferers often already have an impaired wound healing ability and tend to develop bedsores very quickly when bed confined. Bedsores are hard to heal, especially when they have developed on both sides of the body.This is because it is hard to avoid pressure on an affected area no matter what position the person is put in.

Prevention

Because of this, prevention is always better than cure. Prevention requires fairly constant attention by a caregiver which will be difficult to achieve with just a single assistant. As the bed ulcers are caused by pressure, the individual needs to be turned or moved very often, ideally, every half hour to an hour. A compromise would be two hour intervals. This is very hard to achieve and is part of the reason why decubitus (bed) ulcers are often slow to heal. The bedlinen must be kept clean and dry and foam or sponge can be used to lower the pressure at the affected site.

A variety of topical preparations are used to dress the skin. If the skin is still intact, topical zinc oxide ointment can be applied. If the skin is broken, there are a number of topical preparations which aid in wound healing. Sufnexal gel and curiosan ointment are two commonly prescribed preparations, which help wounds heal faster. Topical antibiotic ointments or creams are also used to prevent or treat wound infection.

If the ulcer is deep, surgical cleaning of dead tissue (debride-mint) may be necessary as well as oral antibiotic therapy. If the person is thought to have a general problem with poor blood circulation, medication to augment blood circulation can also be prescribed. Diet and nutrition is important as the ulcers cannot heal if adequate nourishment does not reach to affected tissues. Plenty of water and fluids, fresh fruits, vegetables and a good protein source are important for wound healing. Vitamins A, C, and E and zinc supplement also help wounds to heal.

Topical aloe vera preparations can be used on the skin to soothe and help prevent the breakdown of the compromised skin but should not be applied to an open wound.

When ulcers are present they should be examined by a physician to determine what therapy is best for that individual for wound healing to occur.