Pressure Ulcers: Causes, Timeline, and Care Tips

Pressure ulcer

Hello! I would like to ask Dr.
Cheng, how do pressure ulcers form? How long does it take for them to develop? What qualifies as "long-term bed rest," and is there a specific timeframe for that? Currently, I am taking care of my grandmother, who has limited mobility.
I do help her sit up, so she is not lying down all the time.
I have noticed some black spots on her back, near the spinal area, which I initially thought were bruises, but now there is peeling and redness.
If I need to apply medication, can I use something like ointment? I have been caring for her for about a month; can pressure ulcers develop within this timeframe? (There is very little information available on this condition on various websites, and I appreciate your response...)

bobo, 20~29 year old female. Ask Date: 2002/10/17

Dr. Zheng Lizhen reply Dermatology

Hello! Pressure ulcers, also known as bedsores, occur due to sustained pressure that impairs local blood flow, preventing adequate oxygen and nutrient supply to surrounding tissues, leading to tissue damage and necrosis.
Pressure ulcers commonly develop over bony prominences such as the coccyx, hip joints, heels, ankles, shoulders, and the occipital region, where subcutaneous tissue is thinner.
This condition is prevalent among individuals who lack the ability to reposition themselves, such as those who are bedridden or in wheelchairs.
The progression of pressure ulcers can be very rapid, forming within a few hours, and does not necessarily require "long-term bed rest" to occur.
Other contributing factors include the patient's nutritional status, immune function, vascular condition, and mobility.
As for treatment, early-stage pressure ulcers can be managed with conservative measures: eliminating factors that contribute to their formation, such as relieving inappropriate pressure (patients should be repositioned at least every two hours when bedridden, and those sitting in chairs or wheelchairs should change their weight distribution every 15 minutes), and enhancing nutritional status to boost immunity.
If conservative treatment fails to prevent further tissue damage, surgical intervention should be considered promptly—this includes thorough debridement and administration of antibiotics to prevent further infection or sepsis.
Once the wound is clean, the patient's condition can be reassessed for appropriate reconstructive surgery.
Over-the-counter remedies are not effective in such cases, and it is advisable to seek medical assistance promptly to prevent further deterioration of the pressure ulcer.
Wishing you and your family safety and happiness.
Sincerely, Dr.
Cheng Li-Chen, Department of Dermatology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2002/10/17

More Info

Pressure ulcers, also known as bedsores or decubitus ulcers, are localized injuries to the skin and underlying tissue that occur due to prolonged pressure, often over bony areas of the body. Understanding their causes, timeline, and care tips is crucial, especially for caregivers like yourself who are looking after individuals with limited mobility.

Causes of Pressure Ulcers
Pressure ulcers develop when there is sustained pressure on the skin that restricts blood flow to the area. This can happen in various situations, such as:
1. Immobility: Individuals who are bedridden or confined to a wheelchair are at higher risk. Even short periods of pressure can lead to skin damage.

2. Friction and Shear: When the skin rubs against clothing or bedding, it can cause friction, which, combined with pressure, can lead to skin breakdown.

3. Moisture: Excess moisture from sweat or incontinence can weaken the skin, making it more susceptible to injury.

4. Poor Nutrition: A diet lacking in essential nutrients can impair skin health and healing.

Timeline for Development
The timeline for the formation of pressure ulcers can vary significantly based on several factors, including the individual's health status, mobility, and skin condition. Generally, pressure ulcers can develop within a few hours of sustained pressure, especially in individuals with compromised blood flow or skin integrity.
In your case, since you mentioned that your grandmother has been immobile for about a month, it is indeed possible for pressure ulcers to have developed during this time, particularly if she has been in the same position for extended periods without regular repositioning.

Definition of Long-term Bed Rest
"Long-term bed rest" is often defined as being immobile for more than two hours at a time without changing positions. For individuals who are unable to move independently, it is crucial to reposition them at least every two hours to alleviate pressure on vulnerable areas.

Care Tips for Pressure Ulcers
1. Repositioning: Ensure that your grandmother is repositioned at least every two hours. This can help relieve pressure on the affected areas and promote blood circulation.

2. Skin Care: Keep the skin clean and dry. Use mild soap and water, and ensure that the skin is thoroughly dried, especially in skin folds.

3. Dressings: For existing pressure ulcers, appropriate dressings are essential. While some people may consider using ointments like "萬金油" (a traditional Chinese ointment), it is generally better to use specialized wound care products designed for pressure ulcers. These can help maintain a moist wound environment, which is conducive to healing.

4. Nutrition: Ensure that your grandmother is receiving adequate nutrition, including proteins, vitamins, and minerals, which are vital for skin health and healing.

5. Consult Healthcare Professionals: It is advisable to consult with a healthcare provider or a wound care specialist for a proper assessment and treatment plan. They can recommend specific dressings and treatments based on the severity of the ulcer.

Conclusion
In summary, pressure ulcers can develop relatively quickly in individuals with limited mobility, and it is essential to take proactive measures to prevent them. Regular repositioning, proper skin care, and appropriate nutrition are key components in managing and preventing pressure ulcers. If you notice any signs of worsening or if the ulcer does not improve, seeking professional medical advice is crucial for effective treatment.

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