Medical Conditions Related to Brain Injury
Bed Sores/Wound Care
Last Updated:
The skin is the largest protective system the body has and is divided into 2 layers, the epidermis and the dermis. Over time, decreased mobility, constant exposure and various skin traumas make skin fragile and more prone to breakdown. But there are ways to prevent breakdown from occurring and to encourage healing of skin that has already broken down.
Skin breaks, referred to as wounds, bedsores, pressure sores, decubitus or skin breakdowns, have four recognized stages.
- Stage I
- An area becomes reddened and does not fade for 20 minutes after the pressure is removed.
- Stage II
- The area develops abrasions, blisters or shallow openings in either the epidermis, dermis or both.
- Stage III
- Damage extends through all layers down to the fascia. Some necrotic tissue may be seen.
- Stage IV
- Iinvolves all the layers of the skin, muscles, tendons and often the bone. Contains necrotic tissue.
On the surface, a particular wound may not look serious, but when discovered, patients, especially those with poor mobility (bedfast or in a wheelchair), should immediately seek treatment from a nurse or doctor specializing in wound care. Breakdown can occur below the epidermis, where it is invisible to the naked eye. To find a specialist, check the yellow pages for a wound care center or call a local hospital and ask for an ostomy nurse. A listing of ostomy nurses by area may be found at www.wocn.org . Keep in mind insurance may dictate where care takes place.
There are many treatment options for wound care including moisture barrier creams, wet to dry dressings such as hydrocolloid, duoderm, collagen, as well as surgical and enzymatic debridement (removal of dead tissue). A specialist can help determine what approach is best. Photos of wounds in various stages and information on wound care including the pros and cons of various treatments may be found at www.medicaledu.com.
Because the body requires more protein when healing, nutrition is critical in preventing skin breakdown from occurring. Ask the doctor about having pre-albumin and albumin levels drawn to assure calorie and protein intake is adequate for healing. Sometimes doctors refer wound patients to a nutritionist if there are significant deficits.
One of the most important ways to prevent skin breakdown is to relieve pressure from pressure points. The areas on the body that tend to breakdown faster than others are: heels, outside of the feet, buttocks (sacrum), hips, elbows and the back of the head.
Tips to prevent skin breakdown if bedfast or in a wheelchair:
- Shift weight every 30 minutes for a full minute when in wheelchair
- Change position every two hours while in bed
- Be sure the wheelchair is fitted properly
- Be sure shoes or any restrictive device (braces, casts, clothing) are not too tight.
- Inspect skin daily
- Massage skin with lotion daily
Tracy Hiett has nine years of nursing background, especially in the adult and pediatric rehabilitation field and is certified in rehabilitation nursing and case management. She is currently employed by Willard, Ahrendt Rehabilitation, Inc. in Atlanta, GA.
www.convatec.com - provides information on wound, ostomy and skin care
http://physicaltherapy.about.com/cs/woundcare/ - wound care from the perspective of physical therapy
www.wcon.org - find an ostomy nurse
www.medicaledu.com. - information on different types of wound care
Definitions:
- Collagen
- A protein contained in connective tissue and bones
- Debridement
- To remove dirt, foreign objects, damaged tissue, and cellular debris from a wound or burn in order to prevent infection and promote healing.
- Decubitus
- An inflammation, sore, or ulcer in the skin over a bony prominence.
- Dermis
- The layer of skin where the vascular flow and nerve endings are.
- Duoderm
- Hydrocolloid dressing that manages light to moderate exudates (discharge)
- Enzymatic debridement
- A topical treatment that causes dead tissue to pull away from the wound.
- Epidermis
- The outer, non vascular, nonsensitive layer of the skin covering the true skin.
- Exudate
- Fluid, cells, or other substances that have been slowly discharged from cells or blood vessels through small pores or breaks in cell membranes. Perspiration, pus and serum are sometimes identified as exudate.
- Fascia
- The fibrous connective tissue of the body that may be separated from other specifically organized structures, such as tendons, and ligament.
- Hydrocolloid
- A type of dressing that keeps wounds moist.
- Necrotic
- Pertaining to the death of tissue in response to injury or disease. It is usually black, yellow or green in color.
- Nutritionist
- A person who specializes in assuring the proper intake and nutrients required for a person, especially when the person has medical complications.
- Ulcer
- A circumscribed, craterlike lesion of the skin resulting from necrosis that accompanies some inflammatory, infectious or malignant process.