What Is a Stress Ulcer?

Pressure ulcers, also known as pressure ulcers and bedsores, are tissue ulceration and necrosis due to long-term compression of local tissues, and continuous ischemia, hypoxia, and malnutrition. Skin pressure ulcers are a common problem in rehabilitation treatment and nursing. According to relevant literature reports, about 60,000 people die from pressure ulcers every year.

Basic Information

Also known as: Bedsores, pressure ulcers
English name: pressureulcers

Visiting department: surgical
Common causes: Stress factors, nutritional status, reduced skin resistance
Contagious: no

Causes of pressure ulcers

Stress factor

(1) The main cause of pressure ulcers caused by vertical pressure is that the local tissue is subject to continuous vertical pressure, especially at the bulge of the bones of the body. Pressure ulcers can be caused by prolonged bedridden or wheelchair, improper placement of the splint liner, uneven or slag in the plaster, and localized compression for more than normal capillaries for a long time (generally, the blood vessels under the skin layer can withstand The pressure is about 32mmHg. If it exceeds the above pressure, the local blood vessels may be distorted and deformed to affect the passage of blood flow, and there is ischemia).

(2) Friction Friction acts on the skin and easily damages the stratum corneum of the skin. When a patient moves on the bed or is in a wheelchair, the skin can be rubbed by the retrograde resistance of the sheets and the surface of the wheelchair pad. For example, when the skin is abraded and is impregnated by sweat, urine, stool, etc., pressure ulcers are likely to occur.

(3) Shear force The so-called shear force is a force applied to an object that causes a plane sliding in the opposite direction, which is caused by the addition of friction and vertical pressure. It is closely related to body position, for example, when the bed is raised when lying flat, the body slides down, parallel friction between the skin and the bed, and the vertical gravity of the skin, which results in the generation of shear forces, causing local skin blood circulation disorders and pressure ulcers. .

2. Nutritional status

Lack of systemic nutrition, muscle atrophy, and lack of protection in the stressed area, such as chronic fever and cachexia.

Systemic nutritional disorders, insufficient nutritional intake, reduced protein synthesis, negative nitrogen balance, reduced subcutaneous fat, and muscle atrophy. Once stressed, the skin at the bone carina must withstand external pressure and the skin's squeezing force at the bone carina. The lack of protection of muscle and adipose tissue in the compression area causes pressure ulcers in blood circulation disorders.

3. Reduced skin resistance

The skin is often subject to physical irritation such as dampness and friction (such as improper use of plaster bandages and splints, incontinence of urine, uneven wrinkles on sheets, debris on the bed, etc.), which reduces the skin's resistance.

Clinical manifestations of pressure ulcers

Prone areas

It usually occurs in the bone protuberances without muscle wrap or thin muscle layers, lack of adipose tissue protection and often compression.

(1) The supine position is more common in the occipital tuberosity, scapula, elbows, spinal body bulges, crotch and heel.

(2) The lateral position occurs in the ears, acromion, elbows, ribs, hips, medial, lateral and medial and lateral ankles of the knee joint.

(3) Prone position occurs in ears, cheeks, shoulders, female breasts, male genitalia, palate, knees, and toes.

2. Clinical staging

The latest classification of the National Pressure Ulcer Advisory Group in 2007

(1) Suspected deep tissue damage. Soft tissue under the skin is damaged by pressure or shear. Local skin is intact but may change in color such as purple or maroon, or cause blisters with congestion. Compared with surrounding tissue, the soft tissue in these damaged areas may have pain, lumps, pasty exudation, humidity, fever, or cold.

(2) The first stage of pressure ulcer, stasis, and ruddy period "redness, swelling, heat, pain, or numbness that does not fade for 30 minutes". The skin at the bone protrusion is intact with localized erythema that does not fade. Dark skin may not show obvious pale changes, but its color may differ from surrounding tissue.

(3) The second stage of pressure ulcer inflammatory infiltration phase-"purple red, induration, pain, blister", part of the dermis is missing, showing a shallow open ulcer, accompanied by a pink wound bed (wound), without carrion It may also appear as a complete or ruptured serum blister.

(4) The third stage of pressure ulcers with superficial ulcersepidermal damage and ulcer formation. Typical characteristics: full-thickness skin tissue is missing, subcutaneous fat is exposed, but bones, tendons, and muscles are not exposed, and carrion is present, but the depth of the tissue loss is not clear, which may include sneaking and tunneling.

(5) Stage 4 pressure ulcers and necrotic ulcers-invasion into the subdermis, muscle layer, bone surface, and spread of infection, typical features: loss of full-layer tissues with exposed bone, tendons, or muscles, and some parts of the wound bed have Carrion or charred, often sneaking or tunneling.

(6) Typical characteristics of non-staged pressure ulcers : full-thickness tissue loss, rotten skin (yellow, tan, gray, green, or brown) at the bottom of the ulcer, or eschar adhesion (carbon, brown, or black) on the wound bed.

Pressure ulcer diagnosis

In general, the wounds are accompanied by local inflammation of redness, swelling, heat, and pain. If there are symptoms of purulence and stench, it can be regarded as a sign of local infection. With fever, it indicates a systemic reaction.

1. It is more common in long-term bedridden patients such as paraplegia, chronic wasting disease, large area burns and deep coma.

2. Occurs in sacral, sciatic tubercle and other bulges.

3. The pathological changes of erythema, blisters, and ulcers appear in the area under constant pressure.

Pressure ulcer treatment

The skin of the pressure ulcer is red in the early stage. It can be improved after taking measures such as turning over and reducing pressure. When the superficial ulcers, ulcers and exudates appear on the skin, they should go to the hospital for treatment in time.

1. Drug treatment.

2. Physical therapy.

3. Chinese medicine topical therapy.

4. Surgery.