What is an Ulcer?

Ulcers are wounds that develop on the skin. These wounds are seen most frequently in those with diabetes or who have a low potential to heal from injury. Ulcers can have many causes, however, many are caused by:
  • Loss of integrity of the skin
  • A decondary infection of the site by bacteria, fungus or virus
  • Generalized weakness of the patient
  • Delayed healing

Pressure Ulcers

Pressure ulcers are also known as pressure sores, bedsores, and decubitus ulcers. These wounds are caused by the breaking down of the skin when constant pressure is placed against the skin. Pressure against the skin reduces blood supply to that area, and the affected tissue dies. This may occur when remaining in one position for too long without shifting your weight.

The following factors increase the risk for pressure ulcers:

  • Being bedridden or in a wheelchair
  • Being older
  • Being unable to move certain parts of your body without help, such as after a spine or brain injury or if you have a disease like multiple sclerosis
  • Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow
  • Having a mental disability from conditions such as Alzheimer's disease
  • Having fragile skin
  • Having urinary incontinence or bowel incontinence
  • Not getting enough nourishment (malnourishment)

Pressure sores are categorized by how severe they are, from Stage I (earliest signs) to Stage IV (worst):

  • Stage I: A reddened area on the skin that, when pressed, does not turn white. This indicates that a pressure ulcer is starting to develop.
  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
  • Stage III: The skin breakdown now looks like a crater. There is damage to the tissue below the skin.
  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.

Prevention of pressure ulcers includes:

  • Checking those who are bedridden or cannot move for pressure sores every day (head to toe).
  • Paying special attention to the areas where pressure ulcers often form. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters.
  • Change position at least every 2 hours to relieve pressure.
  • Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.
  • Eat well-balanced meals that contain enough calories to keep you healthy.
  • Drink plenty of water (8 to 10 cups) every day.
  • Exercise daily, including range-of-motion exercises.
  • Keep the skin clean and dry.
  • After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin.

Healing & Treatment

The following measures may help avoid ulcers in those who may be susceptible:

  • Debridement: removal of dead tissue
  • Infection Control: use of antiseptics and antimicrobobials, along with frequent changing of dressings
  • Nutritional Support: administering vitamins and minerals in appropriate doses (ie. protein, vitamin C, vitamin A, Zinc)

For anyone who has developed an ulcer, medical attention should be sought immediately so that a course of care and treatment may be initiated.

Penn Wound Care and Hyperbaric Medicine Can Help

Pressure ulcers are no longer referred to as bedsores but the name change hasn't encouraged an increase in discussion about these wounds that develop when there is prolonged pressure between the skin and bone.

"An aging population along with rising rates of diabetes and other comorbidities mean more and more people are at risk for pressure ulcers," explains Catherine Norris RN, BSN, CWS, CHT at Penn Wound Care and Hyperbaric Medicine. "It is important to become informed and know how to prevent them and how to treat them so that they do not get worse and more difficult to cure." Catherine Norris is Penn Wound Care and Hyperbaric Medicine's Clinical Lead for Outpatient Wound Care and Hyperbaric Medicine. Her team of nurses is highly skilled in treating such cases.

Pressure ulcers occur when a person remains in one position for too long without shifting his or her weight, which decreases the blood supply to the area causing skin and tissue to break down. If not properly treated, these areas may evolve into wounds that can extend down to bone and possibly cause a bone infection or Osteomyelitis.

The primary treatment is to relieve or reduce the pressure. Additional care may also involve removing the non-living tissue from around the wound with surgical instruments or with newly developed dressings and chemical debridement.

The first visible signs of a pressure ulcer may be a red area on the skin that doesn't fade or, for those with darker complexions, persistent areas of red, blue or purple with a different skin temperature or texture.

In addition to the elderly and people with diabetes, others at risk are those with limited mobility, poor nutrition, incontinence and conditions that prevent blood flow and cause lack of sensation.

The experts at Penn Wound Care and Hyperbaric Medicine offer these tips for lowering your risk:

  • Change your position every 15 minutes when sitting and at least every two hours in bed.
  • Donut-type pillows can harm tissue. Purchase commercially available pressure reducing cushions and mattresses but avoid those that resemble egg crate foam.
  • Place a pillow under your calves to prevent your heels from touching the bed and using pillows and foam wedges to keep ankles and knees apart.
  • In treating incontinence, cleanse skin and use a topical moisture barrier. Avoid using plastic-backed linen-saving devices or diapers.
  • Use mild soaps and water when bathing and apply skin moisturizers to prevent dryness.
  • If confined to bed, do not raise the head of the bed more than 30 degrees and use an overhead trapeze to assist in movement.
  • Do not slide across sheet in a Chair or Bed.
  • Do not sleep in a reclining chair.
  • Seek medical treatment if ulcers show warning signs of infection including increased pain at the wound site, redness or swelling spreading away from the wound, a foul wound odor, change in color or amount of drainage from the wound or if you experience fever, chills, nausea or vomiting.

For more information about treating and preventing pressure ulcers and other chronic wounds, contact Penn Wound Care and Hyperbaric Medicine at 610-738-2590.

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