The bedsore

The bedsore - necrosis of the skin, subcutaneous tissue and other tissues developing owing neurotrophic disorders, blood circulation disorders as a result of long their compression. Bedsores are most often formed on parts of the body where the skin is attached to the bone projections: in the area of sacrum and coccyx, the spinous processes of the vertebrae, blades and five - at the position on the back (Fig. 5); the front surface of the knee, ridges Ilium, the front surface of the chest - prone; sciatic Bugrov - in a half-sitting position; rare localization bedsores - the neck and folds under the Breasts. Bedsores can be formed under a plaster cast (in the ankles, heels, the big spit and in other places) in connection with the wrong dressing. Decubitus ulcer may occur on mucous membranes, the so - called decapetala ulcer in the mouth (for example, if poorly fitted dental prosthesis). Rubber pipes, drains, gauze swabs can cause sore in the bowel wall, the edges of the wound, the urethra, trachea , etc., Decubitus walls of the blood vessels of pressure on them drainage and tampons - cause dangerous bleeding.
Especially deep, long-term healing sores are formed by spinal cord injury, often with full break it, with tumors of the spine, slavivshii spinal cord, etc., Occurring disorders of innervation of fabrics make them particularly sensitive to pressure.
Bedsores can seriously complicate severe infectious diseases (typhus, typhoid and others).
The bed sore is always dangerous complication for a patient with severe underlying disease, therefore, requires measures to prevent its development. The important point, contributing to the formation of a bedsore, is untidy the content of the bed, underwear, poor care. Solid shield, which is based on the patient with spinal cord injuries, hard, rough mattress, huddled in the folds of the sheet contaminated with faeces and urine with rough seams and folds his underwear, leftover food in bed, polluted moist skin in combination with constant pressure in places bony prominence contribute to the formation of bedsores. The weak, malnourished patients with cardiovascular insufficiency bedsore can occur quickly - within days.
During the gradual development of a bedsore appears first plot bluish-red colour without clear boundaries (Fig. 1 and 2), then clusively epidermis with preliminary formation of blisters or without them (Fig. 3). Maceration contributes to the infection of this section. Develop necrosis - with no sharp borders, spreading inward and to the side (Fig. 4), with the formation of purulent satikov, an exposure of the muscles, tendons, periosteum. Possible complications of a bedsore mug, a cellulitis, sepsis, gas gangrene. Another type of development of a bedsore - dry necrosis. These sores do not have a tendency to wide spread are very sluggish, and rejection of dead areas is difficult. The intensity following the rejection of the stages of pelletizing, epithelization and scarring depends on the General condition of the patient, the underlying disease course and principles of treatment of bedsores.bedsores photo

Fig. 1 and 2. Cyanosis, preceding the formation of bedsores. Fig. 3. Cyanosis and excoriations skin. Fig.4. Skin necrosis with extensive ulceration. Fig. 5. Place of formation of bedsores (marked in red) in the patient lying on his back.
The bedsore. Fig. 1 and 2. Discoloration of the skin prior to the formation of bedsores. Fig. 3. Primary skin ulceration. Fig. 4. The extensive necrosis and ulceration of the skin, Fig. 5. Places of possible formation of bedsores in the patient lying on his back (marked in red).

Decubitus ulcer (decubitus) - dystrophic, ulcero-necrotic process arising from a lying, weakened serious diseases patients where the soft tissue is compressed between the surface of the bed and subject bone protrusion. Such areas are rump, blades, the greater trochanter, elbow, heel, and so on, Sometimes a bed sore is formed in the field of the occiput.
Causes of bedsores is a long, constant pressure, causing ischemia, and circulatory and neurotrophic disorders, due to the overall poor state of the organism. Thus, it can be bedsores mixed origin, caused only by prolonged pressure, and pressure sores that have arisen only in the neurotrophic disorders (see Trophism).
With the development of a bedsore, regardless of etiology on the affected area of skin first signs of violations of the circulation - pallor, cyanosis, swelling, then exfoliate the epidermis - bubbles that form the plot excoriation, finally, comes the surface skin necrosis, rolling or mummification, or ulceration (printing. Fig. 1-5). If susceptible to infections, dry gangrene goes in the wet. The speed and severity of the distribution ulcero-necrotic changes in the depth and space depend on the participation of endogenous factors in the development of bedsores. In severe P. the womb may be subject, not only the whole thickness of the soft tissue to the bone, but periosteum, and surface layers of bone substance.
Exogenous bedsores are formed from the prolonged pressure on the skin orthopedic devices, plaster bandages, prostheses, etc., the formation of bedsores on the mucous membrane of pressure on her tip after tracheotomy, denture (bed sore gums) and so on
Endogenous bedsores are divided into two types. 1. Bedsores, which is formed due to the General weakness of the body for the patients, who are forced to lie in the same position and from weakness unable to change it. In this case, the pressure leads to the formation of the Isthmus, and the further course it is determined by the overall weakness of the body. 2. Neurotrophic bedsore, in education, which plays the role of a violation of the nervous trophic without the participation of pressure, such as spinal cord injury.
There are three phases of development of neurotrophic bedsore: phase erythema, which quickly followed by the formation of bubbles (bubble phase) with red-brown content. After the breakthrough of bubbles naked necrotic skin (phase ossification), merging with each other. Incontinence of urine and feces in debilitated patients quickly leads to the development of infection, wet gangrene strikes subcutaneous tissue, muscles and in a few days comes to the bones. Erythema is sometimes a few hours after spinal cord injury; within 24 hours, the process goes into torpor, and 48 hours is already gangrene of large areas.
Endogenous decubitus ulcer caused by the General intoxication, depletion, etc., are expanding more slowly. Often without any subjective phenomena in areas exposed to pressure, the skin becomes cold, bluish-purple. After a few days or weeks, with increasing feverish skin is black, beneath a dense infiltrate, with each passing day more and more deep. From under the brim of dead skin appears dirty-brown, smelly, sometimes with fat drops detachable. When probing beneath the edges of the skin found significant gaps that after removing the scab forming vast, filled discolored necrotic stinking masses defect. Necrosis is spreading to neighbouring areas of the skin and often reaches the bone. These sores can achieve big (especially in the area of sacrum) and to serve as a source of sepsis.
If the strength of the patient quickly restored, after the separation of dead tissue granulation in a relatively short time close even big defects. Still pale, flat, sedentary scar. With proper treatment of exogenous bedsores noted, as a rule, the favourable outcome; in endogenous bedsores the outcome largely depends on the course of the underlying disease.