The sores themselves occur when skin overlying a bony prominence breaks down following prolonged contact with a surface, such as a mattress or a wheelchair seat. While pressure sores can be treated with dressings and medication, for some patients reconstructive surgery to repair the affected area is the most definitive treatment option.
What does this condition involve?
During illness, the blood-flow around people’s bodies can be restricted. When someone is immobilised, pressure is generated by the interface between their body and the surface on which they are sitting or lying. This pressure further reduces blood-flow to the contact area, and the surrounding tissue dies. A blister then appears which soon develops into a hole. These holes, or sores, can cause infection and can be difficult to heal.
People who are most at risk of developing pressure sores fall into two categories:
Paraplegics are people who are wheelchair-bound due to paralysis – they may have conditions such as spinal injury, multiple sclerosis or spina bifida. Without feeling in their lower bodies, and unable to move, these people risk developing pressures sores on their buttocks through constant contact with their wheelchair seats.
The sick and the elderly
People who are confined to their bed, including the elderly, people in comas, or people suffering from long-term illness or disability, are at risk of developing ‘bed sores’ on any part of the body that is in constant contact with their mattress. Body parts that are particularly susceptible to bed sores include the heels, the buttocks, the back of the head, the back, and the shoulders.
What treatments are available, and what techniques are involved?
In hospitals and care homes the risk of pressure sores is taken very seriously. Nurses closely monitor patients for sores, and in most care environments there are rigorous prevention schemes in place. Nurses will encourage patients to inspect potential risk areas on their bodies, providing they are physically able to do so. Wheelchair users are often supplied with special cushions designed to alleviate some of the pressure that causes sores.
Unfortunately, prevention is not always successful, and for those patients that do develop pressure sores the affected areas will be treated with initially with dressings. It is essential to identify what has caused the sore and if possible correct this. Managed in this way most pressure sores will eventually heal up although this can take many weeks or months. Sometimes surgery can be considered in an attempt to shorten the time a sore takes to heal.
This image shows a pressure sore on the sacrum, this is a bedsore rather than a chair sore. In surgical repair the sore is excised and two large flaps of skin fat and muscle from the buttocks are raised and moved together to close the defect.
Plastic surgeons will excise the sore and use flap reconstruction to fill the hole. Flap reconstruction involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive. The operation is intended to close the pressure sore and enable the wound to heal, and thus restore normal function as soon as possible.
Is this surgery available on the NHS?
Surgical flap closure of pressure sores is widely available on the NHS.
Who will I see as patient?
As a patient with pressure sores, you will be seen by a multi-disciplinary team. This team will be made up of specialists working together to make sure that the best possible treatment is given. These specialists may include the following:
• Clinical nurse specialist
• Tissue viability nurse
• Plastic surgeon
• Occupational therapist
What should I expect in terms of treatment, procedures and outcomes?
Most patients should expect to be healed pressure relief and dressings. For carefully selected patients surgery can also be helpful. Pressure sore operations are major procedures. You can expect to be in hospital for at least two to three weeks after the operation. Once the sore is healed you can expect a graded sequence of gradually allowing more pressure on the healed area to ensure that it remains healed. It is essential after the operation to maintain all possible measures to relieve excessive pressure and thus prevent further sores.
NICE- Pressure ulcer management