Those people whose relatives are "bedridden" for a long time due to a serious state of he alth, as well as the sick themselves, who are forced to stay in bed for weeks and months, know well what bedsores are. These wounds on the body of patients already weakened by the disease or undergoing major surgery, deliver a lot of discomfort.
If you do not pay attention to them in time and do not take action, they can spread deep into the epidermis, affect the dermis, even expose bone tissue. How to treat bedsores at the initial stage of their appearance, so as not to aggravate the problem? How to alleviate the suffering of the patient, if the moment is missed, and pathological deformities have already affected the muscle tissue? What does this mean for the patient? How to treat bedsores at home? We will answer all these questions in our article.
Introduction to Pressure Sores
Let's briefly repeat the arrangement of human integumentary tissues. Everyone knows that the skin is designed to protect internal organs from environmental influences. Every person, regardless of whether he is an adult or justborn, the skin is made up of many layers. The uppermost is the epidermis. It is on it that we observe the first signs of bedsores. How to treat them will be discussed a little lower. For now, we note that the thickness of the epidermis is very small - only from 0.05 mm (on the eyelids) to 1.5 mm (on the feet).
Under it is the dermis. It accounts for about 90% of our skin. It consists of two layers - papillary and reticular. The dermis contains hair bags, blood and lymphatic vessels, sebaceous glands, nerve endings, collagen fibers, sweat glands.
The hypodermis (in other words, subcutaneous fatty tissue) is located under the dermis. The thickness of this layer can vary depending on the obesity of people. The hypodermis in the composition has connective tissue, nerve endings and many fat cells, between which there are also blood and lymphatic vessels.
Followed by fascia (a sheath of connective tissue), muscle fibers, bones.
According to medical statistics, in Russia, 90% of bedridden patients develop bedsores. How to treat such wounds on the buttocks, coccyx and other parts of the body? Methods have long been developed and are constantly being improved, but the problem remains acute. The main reason is the poor equipment of Russian hospitals with medical equipment, as well as the insufficient responsibility of medical workers who are required to monitor the condition of the skin of bedridden patients. For comparison, let's say that in European countries, only 30% of patients develop bedsores.
The size of such wounds can be different - from very small (onlya few mm in diameter) to giant (more than 20 cm in diameter).
Where and why do bedsores occur
From the above information, it is clear that lymph and blood constantly circulate in the dermis and hypodermis of the skin, and the epidermis protects these layers from any negative external influences. When the skin is squeezed, the movement of fluids in these areas stops. If such compression lasts more than 2 hours, necrotic changes in the tissues begin, called bedsores. How to treat them at the very first stage of development? In most cases, it is enough for a person to regularly do a light skin massage (rubbing) and change the position of his body more often. Otherwise, the necrosis that began in these places spreads to all layers of the epidermis, and after it to the cells of the dermis.
Most often, such wounds form on protruding parts of the body that are most in contact with the surface of the bed:
- Buttocks.
- Heels.
- Scapulas.
- The back of the head.
- Sacrum.
- Elbow joints.
Depending on the position of the person in bed, bedsores can be observed on the following areas of the body:
- Knees.
- Toes.
- Ribs.
- Ichium region.
- Large trochanters of the femur.
- Iliac region.
- Head and ears (on rare occasions).
How to treat bedsores in bedridden patients who are in the hospital, in each case, medical workers should decide. They are also required to fulfill the basictherapeutic manipulations. Relatives can take part in the treatment process by turning the patient over, sitting him on the bed (if his state of he alth allows), stroking and kneading the problem areas of his skin (in the initial stage) to increase blood and lymph circulation in them.
The etymology of the word "decubitus" is based on the fact that the defect is formed during a long lying position. However, such a pathology can also occur in people who are actively moving. We are talking about bedsores in the mouth, appearing from rubbing the mucous membranes with ill-fitting prostheses.
In addition, such wounds often appear in people with fractures of the limbs - due to rubbing and squeezing the skin with plaster bandages.
Classification
Depending on how far the necrotic process of the skin has gone, there are 4 stages of bedsores.
I is the very beginning of pathology. So far, only persistent hyperemia can be seen on the skin, but the epidermis is not disturbed. Some patients do not care about anything in these places, others experience discomfort, sometimes burning pain and / or itching. By the sign that the redness does not go away after the exclusion of compression (nothing compresses the skin, but its normal color does not return), a bedsore can be diagnosed. How to treat such a pathology? So far, the therapy does not cause any particular difficulties. It can be done by people, even those who are very far from medicine.
II is a continuation of the development of the I stage of bedsores. It is still possible to treat such a wound with conservative methods. In stage II, there is a violation of the integrity and stratification of the epidermis,penetration of pathology into the layers of the dermis, but the hypodermis is not yet affected. At the site of the bedsore, one can see hyperemic skin and a bladder filled with liquid exudate. When the patient moves or the careless manipulations of the medical staff, it bursts, exposing a very painful bright red area of \u200b\u200bthe dermis. At this stage, without treatment, any infection easily enters the wound, which will cause suppuration and worsen the patient's condition.
III - this stage is characterized by the continuation of the spread of cell necrosis deep into the skin of the patient. The pathology extends to the hypodermis, but the muscle layer and fascia are not yet affected. Visually, a bedsore at stage III looks like a deep wound with wide edges and a tapering bottom, where a layer of yellow dead tissue is visible. How and how to treat bedsores in a patient at this stage? In most cases, doctors try to use conservative methods. According to medical statistics, only 25% of cases require surgery.
IV is the most difficult and dangerous stage. Necrosis extends not only to the tissues of the skin and muscles, but also to tendons and bones. In some cases, they are visible in especially deep wounds, but more often dead tissue of a dark color is visible on their bottom. At this stage, bedsores how to treat? At home, therapy is not possible, as the patient requires surgical intervention. Consider its features.
Treatment with surgery
Doctors, even if a patient has stage IV bedsores, first try conservative therapy, because itcosts five times cheaper (according to the calculations of American physicians). Other reasons for not having surgery:
- Long (up to 3 months) preparation stage.
- Very long rehabilitation period.
- Technical difficulties (and sometimes impossible) to perform surgical treatment.
- Weak or no effect after the first operation (often it is necessary to repeat this effect several times).
Telling how and how to treat bedsores in a patient, we will explain what is included in the preparation for the operation. In any necrotic ulcer, all kinds of pathogenic microorganisms that can cause suppuration, intoxication, and a severe septic condition are necessarily collected. It is because of this that approximately 20% of patients who develop bedsores die.
Preparation for surgery includes:
- Antibacterial therapy.
- Restore electrolyte balance.
- Rebalancing protein balance.
- Detoxification.
- Restoring water balance.
- Wound care.
- Complete removal of dead tissue.
- Further work with bedsores until vascularized granulations appear in it. If this does not happen, the operation is not performed.
It is clear that there can be no question of performing such manipulations at home. How to treat bedsores in the preoperative period? At the present stage of development of medicine apply:
- Wound dressing with antiseptics and enzymes.
- Stimulation of tissues to regenerate with the help of magnetic andelectrotherapy.
- Impact on the wound with a defocused laser beam.
The latest innovation has reduced the preparation period by 3 times.
Surgical intervention is carried out according to the following methods:
- Skin plasty (a skin flap taken from the patient's body is sewn onto the wound).
- Decubitus excision and further plasty using adjacent skin areas (combination of wound edges).
- Excision with further use of flaps taken from other parts of the body.
After surgery, there are often complications associated with insufficient preparation for a bedsore, poor patient care, infection of the wound, tension of its edges, rejection of the implanted skin fragment.
If grade III and II bedsores do not heal for a long time or often recur, they are also treated surgically.
Conservative therapy for grade III and IV bedsores
Regardless of the severity of the pathology and its location, the first thing to do is to remove or at least reduce the compression as much as possible. This is most difficult to achieve in patients with injuries of the spine and spinal cord. This issue is easier to resolve if a person has wounds from lying on his limbs for a long time. For example, before treating a pressure sore on the heel, a pillow, folded blanket, or any other similar object is placed under the patient's leg in the calf or lower leg area. It must be placed so that the heel does not touch the surface of the bed. For bedsores on the coccyx or buttocks, applyanother decompression method using airbags.
Therapy for pressure ulcers III and IV degrees is carried out exclusively in the hospital. The wound must be cleared of pus (if present) and dead tissue.
Next, sterile dressings are applied using ointments:
- "Thiotriazolin".
- Bepanthen.
- Algofin.
- Iruksol.
- Solkoseril.
Drug therapy is done with drugs:
- Antibiotics.
- Necrolytic agents containing trypsin, collagenase, terrylitin, deoxyribonuclease.
- Hyperosmolar preparations externally in the form of ointments and liniments, drawing pus from the wound, as well as necrosis products.
- Angioprotectors (improve microcirculation of biological fluids in tissues).
- Anti-inflammatory drugs ("Prednisolone", "Hydrocortisone",
- "Dexamethasone".
- Means that stimulate regeneration ("Vinilin", "Methyluracil", "Stellanin").
- Preparations containing silver ("Argocrem", "Dermazin", "Argovit" and analogues).
In addition to drug therapy, patients are prescribed physiotherapy: UHF, electrophoresis, ultrasound, electrotherapy.
Treatment of pressure ulcers II degree
Recall that with such a pathology, tissue necrosis already takes place, but so far it has spread only to the epidermis and dermis. These structures tend to recover quickly. Therefore, it is possible notresorting to emergency measures, treat such bedsores at home. How should this be done? Basic and immutable criteria for therapy:
1. Perfect cleanliness of the patient's clothes and bedding.
2. Providing compression relief. For example, how to treat a bedsore on the coccyx? This part of the skeleton is the lower part of the spine and is represented by several rudimentary fused vertebrae. In fact, this is a modified tail. The coccyx plays an important role, as many ligaments and muscles involved in the work of the intestines and the genitourinary system are attached to it. It is located above the buttocks.
In patients who are constantly lying on their backs, there is a compression of the layers of the skin, muscles and ligaments. Since there is almost no hypodermis in this part of the human body, bedsores develop very quickly here. The situation is aggravated by the fact that the coccyx area is often in conditions of high humidity, as the patient performs acts of urination and defecation for himself. The same picture is observed with bedsores on the buttocks. This part of the body suffers most from moisture and fecal contamination, and therefore requires very thorough hygiene.
To avoid bedsores, as well as in case of their occurrence, the patient needs to be turned every 1.5-2 hours from the back to the right or left side. If it is difficult for him to maintain this position, it is required to put a blanket rolled up in a roll under his back. The best option is to buy a special medical bed and an anti-decubitus mattress (it is equipped with cells into which air is injected).
In the question of how to treat bedsores on the buttocks at home, decompression with the help of such a mattress is also very relevant. If not, you can take the advice of folk healers and sew a small pillow (the size of the buttocks), which you want to fill with millet, rice, lentils or wheat.
You can also provide decompression with the help of special inflatable rubber pads with a hole in the center, which must be placed under the back in the coccyx area so that it does not touch the bed.
3. Massage. It must be performed with light stroking movements, almost without exerting pressure. The wound itself cannot be kneaded, only the skin around it. Massage is needed in order to improve blood and lymph circulation.
4. Sanitation of the wound. This is one of the main points in the question of how to treat bedsores at home. Any sanitization of injured surfaces should be carried out with sterile gloves. If there are none in the house, the person who performs the procedures should wash their hands thoroughly, and then treat them with an alcohol solution. Grade II bedsores develop blisters with exudate inside or an open wound if the skin of the blister bursts. Sanitation must be carried out according to the following scheme:
- Remove previous bandage.
- Wash the wound surface with a disinfectant solution (Chlorhexidine can be used), while removing the remains of the cream or ointment, as well as flaky or flaking skin.
- Rinse disinfectant with saline.
- The wound carefully(without wiping) dry with sterile wipes.
- Apply a germicidal healing spray or cream.
- Cover the pressure sore with a sterile dressing.
It is necessary to carry out the entire algorithm of this procedure every time after the bandage is contaminated in the process of urination or defecation of the patient, or planned once a day.
Creams and ointments Vinin, Levosin, Levomikol, Dermazin and their analogues can be used as therapeutic agents applied to the wound.
5. Provide the patient with quality nutrition.
Therapy for bedsores I degree
This is the most favorable (if I may say so) type of bedsores, since in this case the surface of the skin is not broken. At the first stage, painful redness may appear at the site of the future wound. Sometimes it itches, very rarely it flakes off. In some people, hyperemia is not observed. They feel only a burning sensation or any other discomfort in that place. These harmless symptoms require increased attention and urgent action.
For example, how to treat heel bedsores? The skin on them in most people has practically no hypodermis, so the cushioning between the bones and the surface of the bed is very weak. Patients who are constantly lying on their backs begin to feel a burning sensation in their heels, but hyperemia occurs in a small part of patients. It has already been said above that the patient needs to ensure that the position of the legs so that his heels do not touch the bed.
In addition, a person needs to be turned from back to side, and if he alth allows, then seated soso that he puts his feet on the floor.
It is very important to regularly knead his heels, then lubricate them with camphor or salicylic alcohol, and then apply angioprotective (improve microcirculation) and anti-inflammatory drugs. For these purposes, use "Dexamethasone", "Pentoxifylline", "Troxevasin" and others.
Traditional medicine
Healers have accumulated rich experience and know well how to treat bedsores. The photo below shows the process of preparing one of the potions.
The simplest and most widely available method that can be used for bedsores II and even III degree is applying to the wound cut along the aloe leaf (with the inside to the wound) or crushed Kalanchoe leaf.
Some healers advise bandaging an inflamed wound overnight with a clean cabbage leaf.
Fir oil is used as a bactericidal agent for treating wounds and for compresses. You need to add a few drops of it to boiled water.
The well-known calendula (marigold) also has high anti-inflammatory and antibacterial effects. An ointment from it is prepared as follows: crushed dry leaves without observing strict proportions are added to petroleum jelly and mixed well. The resulting remedy lubricates the wounds several times a day. In addition, you can drink calendula and chamomile tea daily, adding honey to taste.
Mumiyo has proven itself from the best side for a long time. You can buy its solution at any pharmacy. Mummy should be applied to a napkin and applied todamaged surface.
What are dangerous bed sores
The appearance of such wounds on the skin violates the immune status and significantly reduces the ability of the patient's body to resist the underlying disease. The main danger of bedsores is the possibility of infection, which leads to the development of sepsis. Any infection inevitably entails intoxication of the body. Also, patients often have anemia, hypoproteinemia (decrease in the amount of protein in the plasma), amyloidosis of internal organs, leading to kidney and liver failure.
Decubituses are especially dangerous for the elderly. How to treat such people? It is necessary to take into account such age-related changes:
- Reducing the amount of adipose tissue, which negatively affects its depreciation function.
- Decrease in the activity of immune defenses, as a result of which they are more often susceptible to various diseases in younger people.
- Weakened activity of tissue regeneration, that is, they have injuries more often than people of other age categories, and the treatment is harder and longer.
- Many elderly people suffer from various diseases of the internal organs. They often have problems with the work of the intestines and stomach, with the heart and pressure.
These reasons may be a contraindication for surgical treatment, so all hope is only for conservative therapy.
The rules for its implementation in the elderly do not differ from those outlined above. It is important to provide these people with food rich in vitamins, proteins, microelements. Also needmaintain water balance in their body. The elderly need to drink at least 1.5 liters of non-carbonated mineral water per day.
Of course, it is required to observe their hygiene, often change absorbent diapers, while washing the urinary organs, make sure that there are no wrinkles on clothes and sheets, there are no crumbs from food.
Prevention
Doctors believe that the appearance of bedsores in seriously ill patients is an inevitable complication. A particularly sad picture is observed in our country. In many Russian hospitals, even beds with automatically rising backs are a rarity, and there is no need to talk about anti-decubitus mattresses. Therefore, all responsibility for the condition of the patient's skin lies with the medical staff and relatives.
Patients need to maintain hygiene, change soiled bed linen, clothing, provide them with the required amount of absorbent diapers and good nutrition.
Good prevention of bedsores is frequent and regular changes in the position of the patient's body (turning over) and light massage.
These steps will help reduce the risk of pressure ulcers.
