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Introduction on Pressure Sores

Bedsore, also known as pressure soresor pressure ulcer, is a common clinical complication. Local skin is compressed by local pressure that affects blood circulation, and then induces pathological changes of skin

 

Common clinical patients in three categories:

1. Patients with coma or paralysis; 2. Bed-ridden patients and those with poor constitution; 3. Long fixation patients after fracture or bedridden patients

Bedsore is not only the pathological lesion of skin and subcutaneous tissues, but also cause a serious impact on health of human body. According to reports of foreign literature, incidence of bedsore is about 0.4% to 38% in acute lesion, 2.2% to 23.9% in chronic lesion, and 0% to 17% in home health care. The occurrence of bedsore indicates shortage of prevention and nursing intervention, which can affect health, aggravate disease condition due to pain and infection, prolong hospitalization, and even premature death in some patients.

Bedsore means that a certain part of human body (not only ambulatory patients, and also the sitting position inducing skin compression, such as “sitting on wheelchair”, etc) is compressed for a long time that local blood circulation is blocked and induces tissue hypoxia, tissue defect and necrosis. If the pressure is constant that can induce whole-layered skin necrosis and defect, and ulcer inducing bacterial infection. Due to ischemia at ulcer base, of blood capillary at margin and venous, and lots of growing granulation, the areas with ulcer and gangrenous become larger at subcutaneous tissues, and is up to 3 to 6cm within several days. It can get deep subcutaneous tissues about 8 to 10 cm to the margin, and even involve to periosterum or sclerotin, and cause focalperiostitis or osteomyelitis.

More than 95% bedsores are found on bone protuberance of lower extremities. About 67% ulcers are found on areas surrounding hip, and 29% at lower extremities. Bedsores are mainly found at sacrum, greater trochanter of femur, ischial tuberosity, hell and lateral malleolus. These anatomic sites are not always affected as changing body postures, so they are the most dangerous parts to have bedsore.

 

2007 US National Pressure Ulcer Advisory Panel divided pressure ulcer to different types according to their clinical manifestation:

Level I: Epidermis is without damage, just with skin redness. The symptom of skin redness is not improved after removing pressure for over 30 minutes, and this stage is acute inflammation phase.

Level II: Epidermis is with redness, erosion, and bubble. Tissue defect is not invaded into dermis, wound is moist and pink, concomitant with pain, but there is without necrotic tissue.

Level III: Tissue defect is crater shaped, invaded from dermis to subcutaneous tissues, concomitant with exudates and infection, but without pain; necrotic tissues are found.

Level IV: The pressure ulcer is deep to muscular tension and bone, with exudates, infection and necrotic tissues, as nerve damage and severe pain. 

 


Compared with traditional topical treatment, VSD technology has the following advantages:

1. Take timely and effective drainage: VSD drainage tube is surrounded with medical foam materials, which can exponentially expand drainage surface to obviously increase drainage areas, and after being divided and plasticity by foam materials, drain is not easy to block drainage tub, to maintain drainage smoothness. Constant vacuum suction can completely clear away wound surface and exudates in cavity, to avoid local exudates accumulation, accelerate tissue swelling, improve blood circulation and reduce absorption of toxins.

2. Reduce wound infection: Biological membrane is oxygen permeable, moisture permeable, water-proof and bacterial proof. After taking VSD to treat pressure ulcer at hip, semipermeable membrane sealing can effectively prevent urine contamination, reduce route of transmission among patients or between patients and environment, and then to decrease nosocomial infection. It is reported that VSD technology can obviously reduce number of bacterial colonies at wound surface and wound infection rate.

3. Incomparable advantage for deep cavity: VSD can avoid formation of dead space. The bigger and deeper cavity can be gradually reduced by reducing filled foam volume until the cavity becomes smaller or fresh granulation is found. Foam can be removed, if there is without obvious exudates. Simple pressure dressing can close cavity.

4. Relieve patient’s pain, reduce work load of medical staffs. VSD system does not need to change dressings within 7 to 10 days, relieve patient’s pain caused by frequent dressing change, and reduce work load of medical staffs.

5. Treatment time is obviously shortened.

Bedsore treatment should be taken as soon as possible. The principle is to remove pressure at affected area, in order to promote local blood circulation, and enhance wound treatment. Topical medication can also be taken to promote granulation growth. Layer flap transplantation or whole layer flap covering can be used for debridement of big ulcer. For gangrenous ulcer, necrotic tissues can be removed firstly, and above treatment can be taken after complete drainage. Wound fester should be cultured and made drug sensitive test, and the results can be used for choosing sensitive antibiotics. If there is without systemic infection, it does not need to take antibiotics. Critically ill patients should also take supportive therapy. 

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