Bedsores or bedsores

Pressure ulcer care and pharmaceuticals

Phase I and II of the ulcer heal only after weeks or months by:

• conservative wound treatment,
• Avoid the risk factors.

Treatment of the last stage is very difficult.
In a person who suffers from a fatal disease or has multiple chronic conditions, the treatment of pressure ulcers may focus on pain management rather than complete healing of the wound.

Treatment by various professionals
In order to address the multiple aspects of wound treatment, a multidisciplinary approach is required.
Members of a care team include:

• a doctor who supervises the basics of the treatment plan;
• a doctor specializing in ulcers;
• a social assistant who helps the affected person or family to solve the problems associated with long-term therapy;
• a physiotherapist who helps to improve mobility;
• a nutritionist who assesses the necessary food needs and recommends appropriate nutrition;
• a neurosurgeon, orthopedist or plastic surgeon, depending on the type of surgical intervention.

Reducing the pressure on the ulcer The first step in treating a pressure ulcer in each of the phases is to relieve the pressure that was the cause.

The strategies for pressure relief are as follows:

1. 1. Storage. A person with pressure ulcers must be regularly relocated and placed in the correct position.
      People who use a wheelchair must change position as often as possible and need an assistant to relocate every two hours.
      Lifting aids can be used to prevent friction during repositioning.

1. Contact surfaces. Beds, pillows, anti-decubitus mattresses and special pillows can help keep a person in the correct position, reduce pressure on existing wounds and protect the skin from further damage.
   Various air cushions or water-filled devices are helpful for patients who risk pressure injuries.
   There are anti-pressure mattresses with alternating pressure system (air filling), which consist of several air chambers (one at the level of the feet, one under the back, one under the shoulders).
   A compressor inflates part of the mattress while some air is released from another area; After that, he proceeds the other way round. In this way, the body parts are alternately loaded and relieved. On water mattresses, body weight is distributed more evenly due to Pascal’s law.

Remove necrotic tissue

Wounds must not contain infected or necrotic tissue in order to heal properly.
The removal of scab (necrotized tissue) is carried out in different ways and depends on the severity of the injury, the general state of health and the treatment goal.

Among the possibilities there are:
1. Surgical debridement is used to remove dead tissue.

2. Mechanical debridement is based on one of the methods of softening and removing wound covering, such as:

• Ultrasound.
• Versajet, a device that cleans the wound with a jet of isotonic saline and removes the fragments. A high-performance device becomes an instrument that achieves excellent results even after a single treatment for a 4th degree wound.
• Jacuzzi.
• Special medications.

3. Autolytic debridement can support the natural process of inducing the body’s own enzymes to break down dead tissue with an appropriate bandage that keeps the wound moist and clean.
4. Enzymatic debridement shall be carried out using chemical enzymes and appropriate tissues for the removal of dead tissue.

Treatment by wound cleaning and wound care

The care that leads to the healing of the wounds includes:

• Cleaning. It is important to keep the wound clean and prevent infection.
  A wound in the first stage can be carefully washed with water and neutral soap, but open ulcers must be cleaned with salt water (physiological saline) every time the dressing is changed.
• Disinfection. Disinfectants such as betadines (iodine-based), acetic acid, hydrogen peroxide, etc. can have a toxic and irritating effect. Better is the use of isotonic saline or Ringer’s solution, which favors cell proliferation and thus the healing of the ulcer.
  In case of infection (e.g. diabetic foot), antiseptics or antibiotics to be applied locally can be used.
• Medication. A bandage promotes healing, keeps the wound moist, forms a barrier against infections and keeps the surrounding skin dry.
  Various dressing material is available, including:
• Transparent film pads if the lesion does not secrete exudate (inflammatory fluid), but it can be injured by friction or use of patches.
• Hydrofiber dressings, alginates and silver-containing wound dressings for infected wounds or wounds with a high risk of infection. Alginates have a high absorption capacity, they can absorb amounts of liquid that exceed their weight by 10 to 20 times. This type of wound dressing is also used in patients taking antibiotics in oral form.
• Gauze for weeping wounds.
• Gel or hydrogel, releases moisture and is used for dry and painful wounds.
• Polyurethane foam (creates a moist environment). Used for weeping and painful wounds.

The wound dressings adapt to the level of the wound. Perianal ulcers must be checked several times a day due to the high risk of infection.

Other therapies for pressure ulcers
Other measures that can be taken:

• Pain therapy. As a treatment for pain relief, anti-inflammatory drugs can be taken, for example, ibuprofen (Dolormin, etc.) and naproxen (Aleve, etc.). These can be taken before and after positioning the patient, wound care and dressing change.
• Locally acting drugs for pain (for example, a combination of lidocaine and prilocaine) can be used during debridement and dressing changes.
• Medications for local use (e.g. scar care) have a disinfectant and scar-healing effect.
• Antibiotics. Infected pressure ulcer wounds that do not respond to other applications can be treated with local or oral antibiotics.
  Oral antibiotics are prescribed only in case of: sepsis, infectious cellulitis or osteomyelitis.
• Healthy eating. Hydration and proper nutrition promote wound healing. The doctor may order:
  • an increase in calories and fluids,
  • a high content of proteins,
  • a diet rich in vitamins and minerals.
• The doctor may also prescribe the additional intake of dietary supplements such as:
  • Vitamin C,
  • Zinc.
• Relief of muscle spasms. Muscle relaxants can prevent muscle spasms and thus aid in the healing of wounds, which would otherwise be aggravated by the friction caused by the spasm.
  Often prescribed are:
  • diazepam (Valium),
  • Baclofen (Lioresal).

Vacuum-assisted wound closure (V.A.C.)
The latest discovery for pressure ulcer treatment is vacuum wound closure, a healing method already used in physiotherapy to treat adhesions (for example, in Dubuytren’s disease).
The method is based on the creation of a controlled negative pressure on the ulcer. A polyurethane sponge is applied, which adheres well to the surrounding, healthy skin.
The instrument that sucks the secretion out of the wound is connected to the wound via a tube.
The negative pressure favored the dilation of blood vessels and improved the oxygenation of the tissues.

Surgical restoration
Pressure ulcers that do not heal may require surgical intervention.

Natural remedies
In the past, larvae and worms were placed on the wounds, which feed on necrotic tissue and thus allow the reproduction of healthy cells.
Of the ancient home remedies from grandmother’s time, honey and sugar were used to cure an ulcer.

Prevention of a pressure ulcer

Among the strategies there are:
1. Daily control of the skin to detect changes in skin color.
2. Maintain the moisture content of the skin evenly, because the damage is more likely if the skin is too dry or too moist.
3. Use moisture retention products to keep the skin elastic and prevent dryness.
4. Never massage the bony areas, as the skin there is very sensitive.

Diet and lifestyle to avoid bedsores:
1. Feed the person a healthy and nutritious diet. High blood sugar slows down the wound healing process, so cereal products (bread, pasta, pizza, rice, etc.), desserts, potatoes and sugary fruit should be avoided. According to hygienism (a natural medicine), light food or a short fasting cure promote scarring of the tissues.
2. Create good hygienic conditions.
3. If possible, maintain appropriate exercise.
4. Prevent the person from smoking.

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