How to choose the most effective remedy for bedsores: selection criteria

A sacral bedsore is an area of ​​necrosis (death) of skin and soft tissue that occurs as a result of prolonged compression of the skin between the buttocks and the surface of the bed when the patient is forced to lie on his back. The occurrence of bedsores in the sacral area is the main cause of death in patients bedridden as a result of various diseases. Being a chronic purulent-destructive disease, a bedsore can cause general blood poisoning - sepsis. The appearance of bedsores is a consequence of a defect in caring for a bedridden patient at home or in the hospital. Timely prevention prevents the formation of purulent wounds from compression in most patients. This complication does not occur with careful care of a bedridden patient and the use of pressure relief using various devices.

Causes and risk factors

The main reason for the formation of a sacral bedsore is prolonged compression of the skin between the bone and the bed. People who are bedridden cannot change their position on their own. When the pressure exceeds capillary arterial pressure, then there is a violation of blood circulation in this area, which causes the death of the soft tissues of the gluteal region. The development and rejection of these necrosis leads to the appearance of deep wounds, the bottom of which may be the sacral bone. Bedsores do not form with proper care and the use of special mattresses with a massage effect. The pressure exerted on the skin, soft tissues, muscles and bones depends on the weight of the patient and the characteristics of the surface on which he lies (sits). This load often exceeds the capillary pressure in the skin (~32 mm Hg), which reduces the possibility of blood supply in the integumentary and soft tissues. In patients with reduced sensitivity or immobility, compression does not cause changes in body position. In a short time, if preventive measures are not used, they may develop necrosis of compressed skin and the formation of a purulent-necrotic wound.

Treatment at the Innovative Vascular Center

Doctors at the Innovative Vascular Center, treating severe vascular patients with many concomitant diseases, know firsthand about the problem of pressure sores on the heels. Often patients already come to us with such pressure ulcers, sometimes they develop during long-term vascular diseases. The complexity and danger of this problem prompted our surgeons to develop methods for the prevention and effective treatment of bedsores, cleansing the affected tissues in a sick person, because the appearance of bedsores leads to a change in the course of the underlying disease for the worse. We are able to close any pressure ulcers using reconstructive plastic surgery methods.

Stages of bedsores

• The first stage is only reddening of the skin in the sacral area; pain may occur in this area. At the first stage, there is still no deep tissue damage. However, doctors very rarely diagnose such bedsores, since patients do not complain. Only a daily and careful examination of bedridden patients should reveal initial changes and promptly take measures when the stage 1 process begins.
• At stage 2, there is necrosis of the superficial layers of the skin, which, however, does not affect its entire depth. With timely treatment, these necrosis heal without a trace, without leading to serious consequences. Surgery is not required in such cases. Wound healing can be achieved only by local means and unloading of the compression site.
• In the third stage, the skin dies, often along with the underlying fiber and muscle tissue. Such an open wound creates great problems for treatment and care, as it is a purulent-necrotic process with slow rejection of dead tissue. Such bedsores are detected most often and become the main cause of concern for medical personnel. Often at this stage, general toxic phenomena and even sepsis can already develop.
• With the development of stage 4 bedsores, in addition to soft tissue, bone damage occurs. Periostitis and osteomyelitis develop. Purulent destruction of the bone prevents the complete healing of such a bedsore. Very complex operations with resection of bone tissue and reconstructive plastic surgery are required. Only this approach makes it possible to save the patient from inevitable and rapid death.

Reviews

Anna

I would like to express my deep gratitude to Alexander for his professionalism, responsiveness and concern for patients and their relatives, which, unfortunately, is not typical of modern doctors. Alexander promptly came to my mother’s home for a consultation on the treatment of a bedsore, which we tried to cope with for 3 months, involving different doctors. Before this, the healing process was very slow with varying success. Alexander arrived with all the necessary sterile instruments and means for treatment, told and showed how to properly care for a bedsore. He even left the tools and processing equipment so that we had the opportunity, without interrupting the treatment, to order and buy everything we needed. After that, if necessary, he adjusted our treatment. Together with Alexander we dealt with this pain! I will definitely recommend this wonderful doctor! Thank you, Alexander!

Yablonin Boris

Dear Alexander Shadzhievich! I would like to express my sincere gratitude to you for your help. It's hard to overestimate her. From the moment of your first dressing, there was hope that something could be done with such a severe wound. A very important point was the dressing technique, building a wound care system, and the thoroughness and systematic implementation of all subsequent actions. Deep professional knowledge of the processes occurring in the wound, which are noticeable only to a doctor with your experience and knowledge, and most importantly the ability to communicate with a sick person. It helped me a lot that you systematically and consistently explained to me every day what processes occur in the wound, how they manifest themselves and how they can occur. Rarely do any doctors devote such filming specifically to transferring their knowledge to those who must continue caring for the wound at the stage of further rehabilitation. Without seeing the dressing technique with your own eyes, without trying to do it yourself, using your technique with new dressing materials, it would be impossible to continue caring for the wound yourself. It is not surprising that with such treatment, even I was able to see and adopt your thoroughness, attention to the smallest changes in the wound, consistency and commitment to all the small details of your technique. Separately, I simply must thank you for the psychological help that you provided to both me and my sick mother, simultaneously with the treatment of the wound itself. This help allowed me to believe in the possibility of recovery and not give up halfway through this very difficult and lengthy process. Your ability to communicate with the patient and his environment calmly, kindly, without false optimism, and very patiently was a huge moral support for me, instilling faith in the possibility of my mother’s recovery. With a feeling of sincere gratitude and appreciation for the assistance provided.

Shamsutdinova Olesya

I, Olesya Shamsutdinova, am eternally grateful to the surgeon Alexander Shadzhievich for a qualified operation (removal of necrosis) on my mother. For his sensitivity, professionalism and desire to endure, understand, hope... because together it is easier to endure sorrow. Low bow to you.

Irina

In the summer of 2021, we were faced with a very unpleasant and scary problem. Due to a long stay in the hospital and the inability to move due to a broken leg, a bedsore developed on the back (in the lumbar region). In the hospital, unfortunately, it was neglected and at the time of discharge it was assessed at grade 4 severity. Friends advised me to see a doctor, surgeon Alexander Shadzhievich Garmaev. And I want to say that we didn’t regret it for a second. Alexander arrived on the same day, performed all the necessary procedures on the wound, and observed him for several days in a row. The doctor showed how to properly treat the wound and apply bandages. The problem was solved quite quickly thanks to well-chosen treatment and modern drugs. Alexander, thank you for your professionalism, for always being in touch and coming when necessary. The psychological support of the patient and family was invaluable.

Boris

Tatiana

Course of bedsores

At the very beginning, a bedsore appears as a blue or pale spot on the skin. A little later, bubbles appear filled with transparent or cloudy contents. The skin over the affected area becomes dirty blue. A cloudy liquid begins to flow out abundantly from under the burst bubbles. Over time, the rotted skin is opened and underneath it, disintegrated fiber and gluteal muscles are discovered.

After eliminating the factors for the formation of bedsores, their progression stops. However, depending on the depth of tissue damage, the course of bedsores can be different. Most often, there is a slow rejection of necrotic tissue, and then replacement of the defects with granulations and scar.

When a secondary infection occurs, the course of bedsores can become significantly more complicated. Soft tissue phlegmon occurs, which can spread to the bones. From this focus severe purulent intoxication or symptoms of sepsis develop. If bedsores are not treated effectively in a timely manner, the patient may die from this condition.

Preparing to visit the doctor

Before visiting a doctor, do not treat wounds with ointments. To know how to treat bedsores, the doctor will also need information about all the patient’s illnesses and his condition. When accompanying a patient to an appointment, be prepared to answer all these questions: about the bedsores themselves, the reasons for the bedridden condition, the patient’s behavior and other points.

If the situation is advanced and the patient cannot be transported to the clinic in a wheelchair, then a doctor’s visit is required. The preparation is the same: information about the condition, as well as hygiene procedures without additional treatment of wounds.

Complications

Infection is the most common complication of pressure ulcers. There are a variety of anaerobic and aerobic infections, which, if poorly treated, can cause sepsis. The development of sepsis is the main cause of death in bedridden patients. Secondary osteomyelitis occurs in 26% of patients with non-healing wounds on the buttocks. The development of osteomyelitis complicates the course of the wound process and often requires active surgical tactics. Systemic amyloidosis can occur as a result of a prolonged purulent process. It is accompanied by damage to internal organs by a specific amyloid protein. Over time, deeper dysfunction of these organs occurs and the development of a condition incompatible with life. Bleeding from arrozed vessels. An active destructive process in the gluteal region can lead to purulent fusion of blood vessels and severe arterial bleeding from the superior gluteal artery.

Symptoms

There are several stages of necrosis:

• 1. Redness appears, which gradually disappears after changing position and massage.
• 2. There is persistent redness. Various skin disorders are possible - superficial growths, blisters, erosions, etc.
• 3. Obvious lesions of the skin. The ulcers have indentations, are filled with yellow liquid, and emit an unpleasant odor.
• 4. Deep dead areas. Necrosis reaches the muscle mass.

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How to treat

How to treat bedsores that have already appeared at home? At the initial stage, antiseptic and drying agents for bedsores are used, such as: a solution of potassium permanganate, green diamond, fucorcin. As prescribed by the doctor, treatment is supplemented with angioprotectors to maintain blood circulation and vascular tone. When an infectious process develops, the following is used:

• external antibacterial drugs for bedsores;
• ointments with silver ions.

When treating damaged areas of the skin, it is important to be careful and follow the rules for using medications, since improper care of bedsores will only accelerate their development.

Cleansing, absorbent and healing dressings for bedsores are considered an effective method of treatment. It is recommended to treat bedsores with pharmaceutical dressings, which are impregnated with medications that maintain an optimal environment in the affected area. If it is not possible to purchase such dressings, sterile wipes and paper-based adhesive tape will do. Before applying a bandage, the wound must be cleaned of purulent masses and particles of dead skin, and also treated with an antiseptic.

Caring for a patient with bedsores requires patience, knowledge of the basics of treating and dressing wounds, hygiene skills and changing bed linen. In addition, bedridden patients need constant supervision and communication. Relatives often do not have enough strength or time to surround a person with comprehensive care. In such a situation, the optimal solution would be to hire a nurse for a seriously ill patient.

You can entrust the health of your loved ones to the specialists of the “Reliable Support” patronage service. We offer the services of nurses who have the skills of pre-hospital care, housekeeping and psychological support.

How to carry out prevention

Early prevention of bedsores helps to significantly slow down the development of the necrotic process. It is advisable for the patient’s relatives to take care of a special two- or three-section bed, an anti-decubitus mattress and pillows or rubber cushions placed in potentially dangerous areas.

To avoid bedsores, the patient should not remain in the same body position for more than 2-2.5 hours.

It is necessary to carry out genital hygiene daily and change diapers in a timely manner, since bedsores and diaper rash primarily form in the sacral area due to urine leakage.

Daily skin care to prevent bedsores includes:

• thorough inspection;
• air baths;
• wiping with a soft damp sponge;
• cleansing with physiological medical solution;
• treatment with means for the prevention of bedsores (“wet” areas should be dried with powder, dry areas should be moistened with cream);
• light massage with camphor oil on vulnerable areas of the body.

The patient's bed linen and underwear should be cotton and kept in exemplary cleanliness. It is important to maintain a comfortable temperature in the room, since hypothermia or overheating interferes with blood circulation.

It is necessary to control the patient's diet. Doctors recommend focusing on foods rich in protein, vitamins, calcium and iron, and minimizing the amount of simple carbohydrates as much as possible.