Pressure Ulcers
Pressure ulcers, commonly referred to as bed sores, pose serious and even life-threatening risks to those who suffer from them. They are a major source of infection, suffering and mortality in long-term care facilities. The number of people in the US suffering from pressure ulcers is growing, particularly among the growing elderly population. This should warrant serious concern among patients, families, and health care providers.
If you believe you have a pressure ulcer, you can receive a professional consultation with a wound specialist by calling (212) 263-7187.
Click on the links below to learn more about pressure ulcers:
What is a pressure ulcer?
What causes pressure ulcers?
What types of people are at risk of getting a pressure ulcer?
What do doctors mean by the ‘stage' of my pressure ulcers?
Can I expect my pressure ulcer to heal?
What if I am above the age of 65, will my ulcer still heal?
If I have a pressure ulcer, am I at risk?
What is osteomyelitis and, if I have it, how will it affect my wound?
What is undermining?
What treatments are available for pressure ulcers?
Why do i require admission to the hospital for my pressure ulcer?
Why is my wound photographed during clinical visits?
What will be done to address my pain?
What is debridement and how will it help my wound?
How does the surgeon determine what is good tissue vs. non-healing tissue?
What are the risks of infection, and how is this addressed?
Q. What is a pressure ulcer?
A. A pressure ulcer is any break in the skin in an area that has been under prolonged pressure, most commonly by staying in one position too long without shifting weight. Prolonged pressure, particularly on bony areas of the body, limits blood supply, causing tissue damage in the affected area. Pressure ulcers typically occur on the hips, backside, and heels.
Q. What causes pressure ulcers?
A. Pressure ulcers develop when tissue begins to die as a result of diminished oxygen supply to areas under prolonged pressure. However, other factors in addition to pressure that can cause these bed sores are a subject of intense research. Any condition that involves either decreased mobility (i.e. old age or paralysis) or decreased circulation (i.e. diabetes) increases the risk of developing a pressure ulcer. Patients are can be unaware of the wounds, because they are often paralyzed, bed-bound, or elderly undergoing treatment for other diseases.
Q. What types of people are at risk of getting a pressure ulcer?
A. Anyone who places prolonged pressure on one area of the body is at risk of developing a pressure ulcer. However, certain populations are at particularly higher risk, including the elderly, the physically disabled, persons with diabetes or with poor circulation, and patients living in long term care facilities.
Other factors include:
- Bed or Chair confinement - can place excess pressure in certain parts of the body
- Loss of bladder or bowel control - excess moisture can increase risk of pressure ulcer formation
- Loss of mental awareness - prevents a person from shifting weight to alleviate pressure
- Immobility - when a person cannot shift weight on their own, they are at much greater risk
- Poor nutrition - when a person is unable to maintain a nutritious diet, the skin can become more susceptible to injury and ulceration.
Q. What are the stages of pressure ulcers?
A. We categorize pressure ulcers based on the staging system of the National Pressure Ulcer Advisory Board. Pressure ulcers are staged based on the type of tissue and depth involved. Higher stages represent more severe ulcers. In 2007, the National Pressure Ulcer Advisory Board revised its categorization of pressure ulcers, creating an addition two stages:
- Deep Tissue Injury
- Stage I
- Stage II
- Stage III
- Stage IV
- Unstageable
Q. Can my pressure ulcer ever heal?
A. Under our innovative, comprehensive, and compassionate care system, healing is not just an outcome, it's the expectation. Our philosophy that every wound can heal is the focus of care at every level - from our wound clinic to the operating room to our research laboratories.
Q. What if I am above the age of 65, can I expect my wound to heal?
A. On average, elderly persons (ages 65+) with diabetes have more physiological impairments to healing. However, evidence shows that elderly patients still can experience the same frequency of healing as younger populations, although at a slower rate. Thus, it is our philosophy that if treated early and comprehensively, every wound should have a chance to heal, regardless of the patient's age.
Q. What risks are associated with pressure ulcers?
A. Pressure ulcers are chronic wounds by nature. Thus, patients with pressure ulcers have an impaired ability to fight infection in the wound. Unchecked infection can pose serious risks to patients, including amputation and death. Early action is essential to preventing this outcome.
Q. What is osteomyelitis and, if I have it, how will it affect my wound?
Osteomyelitis refers to an infection of the bone, typically caused by bacteria. The prevalence of osteomyelitis in full-thickness pressure ulcers ranges from 17% to 32%. In stage IV pressure ulcers, it is associated decreased healing rates, surgical flap complications, and an increased length of hospitalization. Osteomyelitis may develop within the first two weeks of pressure ulcer formation, and despite treatment may require amputation in lower extremity cases.
"Undermining" refers to overhanging skin edges at the margin of the wound, so the pressure ulcer is larger in area at its base than at the skin surface. It is caused by bacterial infection and commonly associated with osteomyelitis. Surgical debridement is absolutely necessary in the presence of undermining.
Q. How are pressure ulcers treated?
It is imperative for healthcare providers to realize that any patient with limited mobility is at risk of developing a pressure ulcer. Daily examinations of the skin, particualrly around the at-risk areas (hips, backside, heels), is a critical preventive measure for pressure ulcers.
Immediate initiation of treatment from a professional healthcare provider upon the first recognition of skin breakdown greatly improves outcomes. The following is an established protocol for treating pressure ulcers:
- Removal of pressure - from both the wound and other at risk areas.
- Topical dressing - reduces infection and provides moist environment that promotes tissue growth and cellular migration.
- Antibiotics - the proper regiment of antibiotics fights harmful bacteria that inhibit healing.
- Mechanical debridement - diseased, infected, or dead tissue impairs healing and must be removed from the wound.
- Elimination of drainage and cellulitis - through debridement and antibiotics.
- Proper nutrition - malnourish or undernourished patients have reduced abilities to heal.
- Physical therapy - improves blood flow, respiratory funtion, and mental awareness.
In order to maintain an accurate idea regarding the effectiveness of your treatment plan, we also take a photograph of your wound upon each visit to measure its change in area.
Q. Why do I require admission to the hospital for my pressure ulcer?
A. Signs such as new or increasing pain, cellulitis and/or non-purulent drainage or presence of significant undermining may often be herald signs of invasive infection. Patients presenting with these signs and symptoms are at risk of serious complications and require an immediate treatment plan and consideration of admission to the hospital.
Q. Why is my wound photographed during clinical visits?
Our clinical team has designed a Wound Electronic Medical Record (WEMR) to acquire and display the requisite data and provide the decision support necessary to improve the care of patients with chronic wounds. As part of this medical record, photographs are of the wounds are taken upon each clinical visit to record the progress of healing. Using these photographs and a computer program, our team calculates wound area as a method of tracking the healing rate. As part of each visit, you can view these photographs and a graph of your wound area to see improvement over time.
Q. What will be done to address my pain?
A. We treat your pain by addressing the underlying problem. This requires an understanding of the mechanisms of pain and an understanding of all the different options available to correct it. At the NYU Wound Healing and Regenerative Medicine Division, your wound care specialist remains in constant communication with a pain management expert to decide on the best strategy for minimizing your discomfort. If any therapy is not working, you can expect our team to promtly address the issue and make the necessary changes to your pain management plan.
Q. What is debridement and how will it help my wound?
A. Debridement is the removal of dead, diseased or infected tisse from the wound bed to improve the potential for healthy tissue to heal. Dead, diseased, and infected tissue is a source of bactierial overgrowth, which can lead to pain, sepsis, and eventually, amputation. Thus, it must be removed to create the most ideal healing environment. Debridement is a widely employed method.
Q. How does the surgeon determine what is good tissue vs. non-healing tissue?
A. To verify that we have sufficiently removed all of the dead, diseased, and infected tissue, we analyze the tissue that is removed as well as the tissue that is left behind. These specimens are analyzed under a microscope for cellular abnormalities. As well, we utilize genetics studies to research non-healing genes.
Q. What are my risks of infection, and how is this addressed?
Pressure ulcers act as portals of entry for systemic infection, which can have particularly deleterious effects on patients with impaired immunity. Debridement and antibiotic therapy must be initiated as early as possible.
