Decubitus

Pressure sores (also known as pressure ulcers) are localized damage to the skin and/or underlying tissue caused by prolonged pressure, possibly in combination with shear forces. Pressure ulcers most frequently occur in people who are severely restricted in their mobility (e.g. bedridden or wheelchair-bound patients).

Causes and risk factors

1. Long-lasting pressure
   • Lying or sitting in one place reduces the blood supply to the affected tissue areas.
   • Too little oxygen and nutrient supply leads to cell damage and ultimately to tissue death.
2. Shear forces
   • Occur when layers of skin are displaced against each other (e.g. when sliding up in bed).
   • Intensify circulatory disorders.
3. Risk factors
   • Restricted movement (paralysis, bedridden, lack of pain sensation).
   • Underweight (little protective fat and muscle tissue).
   • Overweight (increased pressure on certain areas).
   • Moist skin (e.g. due to sweating, incontinence).
   • Nutritional and fluid deficiency (weakens the skin barrier and delays wound healing).

Body parts at risk

• Sacrum (sacral area)
• heels
• Ischial tuberosity (for seated people)
• Hip bones and thigh bones
• Shoulder blades
• Elbows
• Back of the head (especially in babies or seriously ill people)

Stages of pressure ulcers (simplified according to EPUAP/NPUAP)

1. Stage I:
   • Redness on intact skin that cannot be pushed away.
2. Stage II:
   • Partial destruction of the skin layers (epidermis/dermis). Superficial skin defects, blistering.
3. Stage III:
   • Deep wound with destruction of all skin layers; subcutaneous tissue is visible.
4. Stage IV:
   • Deep tissue loss; exposed muscles, tendons or bones.

Prevention

1. Change of position
   • Regular repositioning of bedridden patients (approx. every 2 hours) to avoid permanent strain.
2. Pressure-relieving aids
   • Special mattresses (alternating pressure mattresses), seat cushions, heel protectors.
3. Skin care
   • Keep skin dry, cleanse gently and take good care of it.
4. Nutrition and fluid management
   • Sufficient proteins, vitamins, minerals and fluids support healthy skin and wound healing.
5. Encouraging exercise
   • Even small movement exercises can help to promote blood circulation and reduce pressure.

Treatment

• Pressure relief of the affected area (positioning and positioning techniques).
• Wound cleansing and wound care with sterile dressings, if necessary use of modern wound dressings (hydrogels, alginate dressings etc.).
• Surgical treatment if necessary (e.g. debridement to remove dead tissue).
• Infection control and antibiotic therapy for bacterial infections.
• Pain control, optimized nutrition and physiotherapeutic measures are important accompanying measures.

Conclusion: Pressure ulcers are a serious problem that can lead to severe pain, infections and even life-threatening complications. Consistent prophylaxis through regular changes of position, pressure-relieving aids, good skin care and a holistic care concept is the most effective protection. In the case of existing pressure ulcers, early and qualified measures are crucial for successful healing.