Bedsore Treatment: Creams, Dressing, for Caretakers

Bedsores, also known as pressure ulcers or decubitus ulcers, occur when too much pressure is applied to an area of your skin for a long time. The pressure prevents blood from reaching the affected area, so the skin dies.

Treatment for bedsores depends on the severity of the sore. Staging uses a universal system based on the level of tissue loss. Therapies can involve repositioning, dressings, and other treatments of the affected areas. Surgery may be needed to repair the bedsores in the most advanced stage.

Bedsore Treatment Based on Injury Stage

Stage 1

Symptoms include:

• Skin is intact with a red or discolored area on light skin, or purple or blue on darker skin, usually located over a bony prominence (areas where your bone is close to your skin).
• Skin does not lighten or blanch (turn white) when pressed, but remains red.
• Redness or change in color does not change within 30 minutes of removing the source of pressure.
• Skin may feel warm, cool, hard, or soft in comparison to normal skin in the surrounding area.
• Sensations of burning, pain, or itching may occur.

Treatment includes:

• Find and remove the cause of pressure on the area.
• Keep the area clean and dry.
• Consider placing a protective transparent dressing over the affected area to protect it from friction.
• Consume adequate calories high in protein, vitamin A , vitamin C, iron, and zinc.
• Increase water consumption.
• Inspect the area at least twice daily.

Consult your healthcare provider if the sore recurs or does not heal within a few days.

Stage 2

Symptoms include:

• The epidermis (outermost layer of skin) is broken by a blister or shallow open sore.
• The dermis (second layer of skin) may also be broken but deeper tissue is not visible.
• The sore is shallow with a pink to red base.
• Pus or other fluid drainage may or may not be present.

Treatment includes:

• Remove the source of pressure.
• Follow the treatment advised for stage 1 bedsores.

Contact your healthcare provider for instructions on how to heal bedsores, which may include the following procedures:

• Cleanse the wound with water or saline solution and dry carefully.
• Apply a thin foam dressing such Allevyn or a hydrocolloid dressing such as DuoDERM, which can be left on until they wrinkle or loosen, usually about five days.

Or, apply a saline-dampened gauze, which is changed twice daily and kept damp between dressing changes.

Stage 3

Symptoms include:

• The wound is craterlike and noticeably deeper than in stage 2.
• Skin over the sore is broken through the dermis (second layer of skin) and into the subcutaneous (below the skin) and fat tissue.
• Bone, muscle, and tendon are not visible.

One or more of the following signs of infection may be present:

• Redness around the edges of the sore
• Pus
• Odor
• Fever
• Greenish drainage from the sore
• Possible necrosis (black, dead tissue)

Treatment includes:

• Remove pressure and see your healthcare provider immediately.
• Special wound care administered by a healthcare provider is often necessary due to the high risk of developing a life-threatening infection.
• Special cleaning or debridement treatments (treatments that remove dead tissue using a scalpel, chemical solution, whirlpool bath, or biosurgery) may be needed.
• Antibiotics (creams or pills) may be necessary to treat infection.
• In cases of infection, antibiotics may be prescribed.
• A special mattress or bed may be prescribed to relieve pressure from the affected areas.

Stage 4

Symptoms include:

• The wound is so deep that there is damage to the underlying muscle and can reach the bone, sometimes involving tendons and joints, which are visible.
• A large amount of drainage and dead tissue, which may appear black, are present.
• There is a high possibility of infection with bad bedsores at this stage.

Treatment includes:

• Contact your healthcare provider immediately.
• Surgery is often required for a wound this severe.

Unstageable

Symptoms (which prevents staging from being determined) include:

• Bedsore is covered with debris or eschar (a thick, crusty surface)
• Slough (dead tissue separated from living tissue) that is yellow, tan, brown, or black may be present

Treatment:

• Removal of the eschar and/or slough is necessary to expose the base of the wound to allow for staging. A stages 3 or 4 bedsore is usually revealed.
• Stable (dry, adherent, intact) lesions without erythema (abnormal redness) or fluid, such as eschar on the heels serves as a natural cover and should not be softened or removed.

Deep-Tissue Pressure Injury

Symptoms include:

• Intact or non-intact skin with a localized area of damage to underlying tissue due to pressure and/or shearing forces
• Persistent, nonblanchable, purple-to-maroon colored areas of broken skin or unbroken skin or blood-filled blisters caused by damage to the underlying soft tissue
• The area may feel firmer, softer, warmer, or cooler, than the surrounding tissue.
• It may be difficult to detect in dark skin tones.
• A thin blister over a dark wound bed may develop and evolve to become covered by a thin scar.
• Progression may be rapid exposing additional layers of tissue even with appropriate treatment.

Treatment depends on the staging of the bedsore, which can be challenging because the ulcer can appear as stages 1 or 2 on the surface, but it could be as deep as stages 3 or 4 under the surface.

Cleaning Bedsores During Treatment

Your healthcare provider will recommend the most appropriate technique for cleaning your bedsores during treatment. To reduce your risk of infection, clean a bedsore every with each dressing change. Common guidelines for cleaning bedsores during treatment include:

• Clean stage 1 bedsores with a mild soap and water. A moisture barrier can be used to protect the area from bodily fluids as needed. Consult with your healthcare provider about the type of moisture barrier most appropriate for your condition.
• For stage 2 bedsores, remove loose, dead tissue using a saline (salt water) rinse or a specific cleaner advised by your healthcare practitioner.
• Do not use iodine cleansers or hydrogen peroxide unless advised to do so by your healthcare provider. These substances can damage your skin.
• Do not attempt to clean stages 3 or 4 bedsores at home. These bedsores usually require treatment administered by a healthcare provider.

When bedsores require treatment from a healthcare provider, debridement (removal of dead tissue) may be used to convert a chronic wound into an acute wound so it can start to heal. Your healthcare provider may use one of the following debridement techniques to clean dead tissue from a bedsore:

• Surgical debridement: Dead tissue is scraped and removed using a blade or scissors.
• Cleansing and pressure irrigation: Dead tissue is removed using high-pressure water jets.
• Ultrasound: Dead tissue is removed using low-frequency energy waves.
• Laser: Dead tissue is removed using focused beams of light.

Dressing Bedsores as Treatment

Dressing bedsores as treatment helps to prevent infection and promote healing. The specific dressing used varies based on the staging of the bedsores being treated.

Follow instructions from your healthcare provider regarding the type of dressing to use. Factors such as the stage and size of your bedsore can determine whether a film, gel, gauze, foam, or other type of dressing would be most effective.

Generally, the goal is to keep the bedsore covered with a dressing to protect it against infection. If using gauze, it should be kept moist between dressing changes to promote healing.

Dressings are usually occlusive, meaning they are placed on the skin after a thin layer of treatment is applied to protect the skin and create a barrier to moisture loss. They are used in the following ways:

• Clean and dry the bedsores: Dressings are changed weekly, avoiding more frequent changes to prevent removing healthy cells along with debris.
• Contaminated or weeping bedsores: Dressings are changed more frequently, as often as every few hours.
• Heavily contaminated bedsores: Dressings can be treated with negative pressure wound therapy, also called vacuum-assisted wound closure therapy. These wound dressing systems continuously or intermittently apply what is called subatmospheric pressure to the surface of a wound to draw out fluid and infection and promote healing.

Certain dressings are used to protect and accelerate the healing process of the bedsores. These dressings include:

• Hydrocolloid dressings: These dressings contain a special gel that encourages the growth of new skin cells in the bedsore and keeps the nearby healthy area of skin dry.
• Alginate dressings: These dressings are manufactured from seaweed that contains calcium and sodium, known to accelerate the healing process. Honey-impregnated alginate dressings can accomplish total wound healing for bedsores.
• Nano silver dressings: These dressings use the antibacterial property of silver to clean a bedsore.
• Creams and ointments: These topical preparations prevent further tissue damage and help promote the healing process.
• Dilute acetic acid: This dressing works to change the pH of a bedsore that is alkaline and contains a biofilm, a community of bacteria that is covered in a protective sticky substance, which most antibiotics can’t penetrate without intervention.

Surgical Treatment for Complicated Bedsores

Surgical treatment for complicated bedsores can be necessary when the sores become too deep or large to treat. Surgery is a two-step process that includes cleaning and reconstructing the affected area.

Surgical treatment starts with debriding the wound. This is done to remove dead or infected tissue. It may also require removing infected bone. While the procedure creates a larger wound, the remaining healthy tissue is more likely to heal than the damaged tissue that was removed.

After the affected area is cleaned, a surgeon covers and closes the area with healthy, thicker tissue with a good blood supply. This can be accomplished in one of two ways, as follows:

Skin Flap

A skin flap procedure involves detaching a flap of healthy skin and tissue close to the wound so that it can be pulled over the wound to cover it. Since part of the flap remains attached to blood vessels connected to healthy skin and tissue, the flap has a source of healthy nourishment as it heals. Covering the wound with skin and muscle is used to repair bedsores over large bony areas (usually at the base of the spine, hips, and the upper end of the thighbones).

Skin Graft

A skin graft involves removing, or harvesting, a flap of healthy skin and tissue from another area, such as your back, buttocks, or thigh, and moving it to cover the wound. Skin grafts can be effective for treating large, shallow pressure sores.

Surgery can improve the quality of life for some people. However, it is not always successful. Frail older adults and those with other disorders, such as undernourishment, may experience complications that prevent full wound repair if the underlying conditions are not addressed.

Evidence-Based Remedies to Complement Bedsore Treatment

Bedsore treatment can be extensive, often involving an individualized comprehensive care plan. Its aims are to:

• Promote wound healing
• Prevent wounds from worsening
• Ease pain
• Prevent infections.

While treatment varies based on the severity of the bedsore and guidance from your healthcare provider, the following evidence-based therapies may be used to complement your bedsore treatment:

Change Positions Regularly

Changing positions with the following methods relieves pressure over bony areas since continuing to put pressure on an ulcer can delay healing:

• Provide a foam support surface based on the individual need for redistribution of pressure and reduction of shear (when skin moves in one direction and underlying bones move in the opposite direction).
• Use a powered or unpowered support surface such as foam-, air-, or gel-filled devices, or air-fluidized mattresses or cushions with the capability to change its load distribution in response to applied loads.
• Use mattresses that alternate pressure to support surfaces in people who have limited mobility and are unable to change positions in bed.
• Avoid prolonged sitting on the bedsore. When seated, use a seat cushion to support proper postural alignment, weight distribution, balance, and stability.

Maintain Moisture

Protect the skin against moisture-associated damage, including dermatitis associated with incontinence, with products that create a protective layer that maintains hydration while blockin external sources of moisture and irritants, such as:

• Barrier ointments
• Liquid polymers
• Cyanoacrylate

Relieve Pain

The following can help ease pain from bedsores:

• Medications can reduce pain levels and enhance comfort and quality of life during the healing process.
• Talk to your healthcare provider about the use of topical morphine to avoid the need for systemic opioids and their effects,

Maintain Nutrition and Hydration

Continue to eat well and stay hydrated, as follows:

• Maintain increased needs for energy by consuming protein, arginine, zinc, and vitamins A, C, E, and K, which are all necessary for wound healing,
• Hydration is needed to preserve and repair skin. Avoid dehydration, which can interfere with wound healing.

Address the Psychological Effects

Incorporate psychological support into care to address the following:

Summary

Bedsores are common problems that occur when an area of skin remains in the same place under pressure for long periods. They often affect older people and those who have limited mobility.

Treatment depends on the stage, or severity of a bedsore. Prompt treatment can help prevent severe problems and the progression to severe stages. The most extreme bedsores can increase your risk of life-threatening infections,

Contact your healthcare provider if you notice symptoms of bedsores. Bedsores are easiest to treat at their early stages when the risk of infection is lowest.