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Third Degree Burns and Bedsores

Bedsores or bed ulcers are areas of ulcerated or damaged skin that happens when the skin and underlying tissue over a bony prominence is compressed between that bony prominence and an external surface for a prolonged period of time, the unrelieved pressure on the skin and underlying tissue will lead to compression of the blood supply to that area. As a result of the decreased blood supply and oxygen the skin begins to die forming an ulcer. Friction of the skin created by the body sliding over a bed sheet, etc contributes also to the skin injury and the formation of ulcer, too much moister such as sweat and urine may also contribute to the formation of an ulcer. Although pressure ulcers can happen anywhere in the body, the hips, heals and buttocks are common sites.

Risk factors:

  • Persons at a high risk of developing pressure ulcers are those who are immobile due to an injury or an illness such as third  degree burns. Any injury or illness that leads to immobility or causes the patient to be bedridden for a long time will increase the risk of pressure ulcers.
  • Persons who have decreased or absence sensation due an injury or illness are also at risk.
  • Older persons have a higher risk because of their increased incidence of debilitating diseases and the thinning and fragility of their skin.

Clinical features:

Bedsores are classified into four stages depending on the severity

Stage 1: The skin is intact with pink or red coloration that doesn’t blanch with pressure; skin may be itchy, painful and may feel worm to the touch.

Stage 2: Partial thickness skin loss. There will be blistering or an open sore (ulcer), the area is red, painful and swollen, dead tissue may be present.

Stage 3: Full thickness skin loss, crater like ulcers are present that extends to the subcutaneous tissue.

Stage 4: Full thickness skin loss with the involvement of muscle, tendon, bone or joint.

Treatment:

  1. Treatment of bedsore starts by identifying and managing the underlying cause.
  2. Relieving pressure by changing position and using pressure relieving mattresses or cushion is important for healing.
  3. The treatment of a bedsore depends on the stage of the ulcer. When the skin is intact, removing the pressure will allow the pressure ulcer to heal.
  4. Pain medication may be used when the bedsore is painful.
  5. When the skin is broken, the protective barrier is no longer present leading to an increased risk of infection; antibiotics may be used when there are signs of infection.
  6. When dead tissue is present, it should be removed by debridement as dead tissue increases the risk of infection and interferes with healing.
  7. Cleansing the wound and dressing changes are important in decreasing infection.
  8. Special dressings can be used to promote healing of bedsores.
  9. Deep ulcers especially those beyond stage 2 may be difficult to treat and if they are deep, they may require surgical repair.
  10. Transplanting healthy skin to the affect area may be needed in some cases (Skin graft)
  11. Topical negative pressure therapy (suction) may be used in some cases.
  12. Your health care provider will decide what the best treatment options for you are and will assess the healing progress.
  13. Healing time varies from days to months and some may not heal especially when there is an associated illness.

Prevention:

  1. Frequent changes in the patient’s position, turning them every 2 hours in bed and every 30 to 60 minutes in a chair.
  2. Checking the skin every day for redness, bruises and blisters and documenting the findings.
  3. Keep the skin clean and avoiding dryness by using moisturizers.
  4. Adequate fluids, protein, vitamins and minerals should be encouraged and correction of malnutrition when present.
  5. Using foam cushions or pads or other supporting devices on the beds and chairs, ask your healthcare provider about the one that is suitable for you. Donut shaped cushions are not recommended as they may interfere with the flow of blood.

Complication:

  1. Septicemia which is spread of infection from an infected ulcer to the blood.
  2. Bone infection (osteomyelitis) from an infected ulcer.
  3. Limb amputation in severe cases.