Bedsores: stages and degrees of bedsores

A pressure ulcer (also called bedsores or bedsores and pressure ulcers) means skin lesions and lesions of the underlying tissue due to long-lasting pressure on the skin.

When a person is bedridden, the weight of the body presses on the skin that lies between the bone and the mattress.
The consequences are:

  • decreased or interrupted blood flow to skin tissue,
  • insufficient oxygenation of the skin.

Areas that have an increased risk of bedsores are where the skin has direct contact with the bone because there are no muscles and tendons, for example:

  • Heels
  • Ankles
  • Hips
  • Back (coccyx region).

An elderly person is particularly at risk, especially if they suffer from a condition that allows them:

  • confined to bed for a long time,
  • in the ability to change one’s own situation.

A toddler or newborn with a physical disability may develop ulcers because:

  • it does not move,
  • is always in the same position.

Only very rarely do you see patients who develop a wound after a fracture and long-term plaster cast.
Decubitus ulcers can develop very quickly and are often difficult to treat.
Various strategies can help prevent pressure sores and promote their healing.


Stage of pressure ulcers

First degree. The lesions are not open wounds. The skin may hurt but has no interruptions or cuts.
The skin appears red and does not turn pale (it loses little color when you press it with your finger and then take your finger away again).
In a dark-skinned person, the spot may take on a different color from the surrounding skin, but does not have to appear red.
The skin temperature is often warmer.
The wounds of the first stage can:

  • ache
  • be harder than the surrounding area.

Second degree. The skin tears open, sags or develops an ulcer, which is usually painful. The wound expands into deeper layers of the skin, up to the dermis. It has the appearance:

  • a graze,
  • a bladder,
  • of a slightly deepened crater (depression) in the skin.

Sometimes in the second stage, a bubble is formed, which contains a clear liquid. Some parts of the surrounding skin may:

  • reddened
  • be irritable.

Third degree. The wound worsens, extending under the skin and forming a deeper crater.
Parts of the subcutaneous tissue are irreparably damaged and can die.
The lesion also affects the muscle tissue.

Fourth degree. The ulcer is very deep, reaches the muscle and bones, causing necrosis (dead cells) in an important area of tissue.
One can observe injuries to deeper tissues:

  • Yearning
  • Joints.

The most severe bedsores develop:

  • on the coccyx,
  • on the heels.

Suspected lesion of deep tissues
Sometimes pressure ulcers do not go through these stages.
In some cases, a deep, painful wound is expected, but this is not confirmed.
If the wound is not open, but the tissues under the skin are damaged, then this is called deep tissue injury. The skin area can:

  • violet or
  • be coloured dark red,
  • form a bladder filled with blood.

Lesions without stage
There are also pressure ulcers that proceed “without stages”. This means that the situation is not clear.
In these cases, the ulcer is covered by a thick layer of:

  • other tissues,
  • and pus.

The deposits form a scab (dead tissue) that:

  • yellow
  • grey
  • green
  • brown
  • can be black.

The doctor can not see the bottom of the ulcer to determine the stage.

Causes of pressure sores

  • Decubitus ulcers occur when the patient cannot move and thus remains in one and the same position for a long time.
  • Normally, man moves constantly, even during sleep.
    This prevents wounds from developing.
  • People who are unable to move experience pressure on the same part of the body for a long time.
  • A sick person who is confined to a bed or wheelchair risks getting pressure ulcer damage.

Various factors can increase the risk of bedsores, for example:

  1. Immobility – lack of mobility due to age or illness.
  2. Emaciation or malnutrition – there is not enough padding over the bony areas.
  3. Slipping down in bed or on a chair – the pressure on the skin blocks the blood supply because the skin is pulled in different directions.
  4. Pressure and friction on the skin, for example from the bed linen.
  5. A patient can develop the wounds in the last 2-3 days of his life, even if the prevention was done correctly.
  6. Overweight
  7. Inappropriate diet – according to natural medicine and blood type diet, there are foods that promote ulceration, while natural foods prevent this disorder.
  8. Lack of water (dehydration).
  9. Moist skin – for example due to sweating or incontinence.
  10. Other conditions such as:

Symptoms of pressure ulcers

Symptoms of a pressure ulcer include:
1. Red skin that worsens over time.
2. A blister forms in the area and eventually an open wound.
3. If the wound is infected, fever may occur.

Complications of pressure ulcers

Untreated bedsores can lead to various secondary diseases, including:
1. Blood poisoning or sepsis (bacteria invade the bloodstream) 2.Infectious cellulitis (inflammation of the tissue, causing swelling and redness) 3. Bone infection (osteomyelitis) and joint inflammation (synovitis) 4. Abscess (an accumulation of pus)
5. Squamous cell carcinoma (Marjolin’s ulcer)

6. Fistula
7. Tissue calcification

Evaluation of a pressure ulcer

To evaluate the ulcer, the doctor must:
1. determine the size and depth of the wound;
2. check whether liquids or foreign bodies indicate a wound infection;
3. determine whether odours are present which indicate infection or dead tissue;
4. examine the surroundings of the wound to see if there are signs of tissue damage;
5. Look for other pressure points on the body.

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