Wound Care
Pressure sores occur as a result of circulatory disorders in soft tissues, usually on the bone protrusions, which are exposed to pressure in the body. In the old nomenclature, these wounds were described as decubitis ulcer. Decubitus ulcer and bed sores, which are derived from the Latin word decumbere, meaning bedtime, are also used synonymously with pressure sores, but pressure sores are not sufficient only for inpatients but also for wheelchair users. Since pressure is the most important factor in the development of these wounds, the term pressure sores is considered the most accurate nomenclature.
Although pressure sores appear to be a problem for chronic patients, the onset of ulcers often coincides with the acute phase of the disease. This is because attention is directed to the patient's primary problem during acute illness and the risk of developing ulcers is often ignored. 63% of ulcers develop while the patient is still in hospital. It has been reported that 41% of cardiovascular diseases, 27% of acute neurological disorders and 15% of orthopedic injuries develop compression pressure.
Pressure is the most important factor in the development of pressure sores. Soft tissues, especially under the pressure of the bone protrusions due to the compression of the tissue can not be fed and continuous pressure is not prevented ulcers and tissue death develops. In paralyzed patients, the defect in pain and loss of movement leads to the inability to detect the pain associated with the pressure and to eliminate this pressure due to loss of motion even if it is detected.
External factors such as moisture, infection, friction, and shear forces generated during transport of the patient, as well as patient-related factors such as general condition disorder, nutritional problems, advanced age, diabetes and edema, facilitate the development of pressure sores by reducing tissue resistance to pressure.
Classification of Pressure Wounds
In pressure sores, there are 5 stages according to the most commonly used classification, although different classifications are used for the depth of the wound.
Stage 1: Skin redness and edema. If pressure is removed and well maintained, the damage is reversible and recovery is often complete.
Stage 2: There is advanced superficial tissue death into subcutaneous tissue. Non-surgical treatments can improve.
Stage 3: There is full-thickness tissue death in the skin. The damage was reduced to subcutaneous tissue. If secondary infection is added, the wound becomes challenging. Surgical intervention is required for large lesions.
Stage 4: The damage includes the bone tissue and the bone descends to the protrusion. Treatment is surgery.
Stage 5: The lesion has spread to bone tissue, joints and body cavities. Bone infection, pathological fractures, joint dislocations, internal organs may become mouth, bacteria may occur in the circulation. According to the spread of the damage, both are always serious cases. Treatment is surgery.
This classification may not always be clinically observed. Often the damage to the pressure wound is cone-shaped. The top of the cone is in the skin and the base is between deep tissues.
Occasionally, a small lesion on the skin may develop a 4th and 5th stage pressure sores.
PREVENTION OF PRESSURE WOUNDS
The precautions to be taken to prevent pressure sores are easier and more economical than the treatment of pressure sores.
The first step in the prevention of pressure sores is education. The patient, family, hospital staff should be informed about the causes and consequences of the wound. The most effective method to prevent these wounds is to change position frequently and to provide movement to the patient as quickly as possible. These patients should be changed positions at intervals of at least 1-2 hours.
People in wheelchairs should raise themselves with their hands every 1-2 hours to ensure that these areas are blooded.
Skin and bed care is very important. The skin should be wiped with soapy water every day and dried so that no moisture remains. Massage should be applied to increase blood circulation and durability of the skin. Bed linen should be clean and dry. The bed and linen under the patient should not be folded.
Urine and cleaning after defecation is very important for bedridden.
Anemia, protein deficiency, vitamin deficiencies, improper dressings and splints, which may cause pressure sores to open, should be eliminated.
Muscle and joint stiffness in patients with stroke should be tackled. Although many beds, wheelchairs and cushions have been developed to prevent the formation of wounds, a device that prevents all of the pressure sores has not been produced yet.
Treatment
Non-Surgical Treatment: If pressure sores are opened, necessary precautions should be taken before they become difficult. In stages 1 and 2, if the pressure is removed and a good care is taken, the healing is achieved automatically. If the pressure persists, the wound deepens and becomes difficult.
Many creams are used in wound care. Despite the rapid progress in wound care in recent years, topical agents are being used in many places that can delay wound healing and damage tissues. The ideal solution for wound cleaning is saline which will not harm the tissue. It is now known that betadine (batikon) solution damages living organisms as well as damaging microorganisms that are the source of infection. Today, newly produced antiseptics are replacing betadine.
Although superficially used antibiotics are still controversial, they develop resistance to antibiotics in bacteria in a short time. Antibiotics given systemically cannot reach the wound sites due to the barrier formed in these wounds. Systemic antibiotics should be given against secondary infections.
Although the bacterial flora changes frequently in these wounds, bacterial culture should be taken by taking samples from the wound in terms of nosocomial infection, and treatment related to urinary bacteria should be shaped.
Many synthetic and semi-synthetic materials have been developed in wound care in recent years. With appropriate patient and wound selection, these wound care materials accelerate the treatment process and reduce the total cost. Wound care products prevent fluid, electrolyte and protein loss from the body and are effective against colonization of bacteria.
There are also various agents that accelerate wound healing. Hydrotherapy, hyperbaric oxygen, ultrasound, electric currents, some topically used pomades are useful in superficial wounds where skin supplements are not lost.
After removal of the dead tissue in deep wounds where the skin appendages disappear, all wounds can be closed by epithelization from the edges with good topical care. The scar tissue, however, lacks skin patches. It may cause continuous pressure sores. Large scars that heal with scar tissue may develop malignant skin tumors in later stages.
Surgical Treatment: 3.4. In the 5th and 5th stages, surgical method is used to treat pressure sores. If the patient's blood values are low in the preoperative period, it should be brought back to normal values that may be operated.
In order to be successful in the treatment of pressure sores, the dead tissue must be removed as soon as possible (surgical debridement of the wound). Although enzymatic debridement methods are used for this, surgical debridement and defect repair should be preferred. The aim of the treatment is to bring pressure-resistant, well-blooded, intact tissues to the wound site. Suitable wound care dressings (hydrocolloid and hydrofiber dressings) are used for this purpose. Since the muscle-skin and fascia-skin flaps used in repair are well-blooded, they provide superiority to other repair methods in the fight against infection at the wound site.
Postoperative Care:
Postoperative care of patients with pressure sores is very important. Patients with flap are usually not laid on the flap for 3 weeks. In this period, starting from the first week, the patient can be given passive movements to the joints according to the surgical characteristics. Prevention of cypasticity after surgery is very important for wound removal. Vacuum drains 5-7. days, the patient is dressed in an elastic corset. Sutures are removed after 10 days. If there is no complication in flap cases, after 3 weeks, patients may begin to lie on the flap. This process starts with 15 minutes per day and can be increased every 5 to 5 minutes. This period should never exceed 2 hours.
Mean duration of hospitalization in patients with pressure injuries is 5-6 weeks. When the surgical costs are considered, it is seen that the precautions to be taken to prevent these wounds are easier and more economical.
VACUUM WOUND TREATMENT (VACUUM ASSISTED WOUND CARE SYSTEM)
What is it: It is a wound healing method with the mechanism of removing the wound liquid from the wound area with the closed-circuit negative pressure system to be applied on the wound. As the healing rate is very advanced compared to classical wound treatment, it is a preferred treatment method in recent years.
How it works: It works by applying continuous or intermittent, controlled subatmospheric pressure to the wound using an electric pump with a special dressing and a connecting tube.
Components:
A special dressing that is usually used sponge. For deeper wounds gray sponge, superficial wounds white sponge is preferred.
Airtight Cover
Collector providing connection between device and dressing
Container where wound fluid drained by Negative Pressure is collected by a closed system
Measure of this pressure that applies negative pressure to the system
Which Wounds Are Suitable
Healing Process Prolonged Open Wounds
Diabetic ulcers
Bed Sores (Pressure Ulcers-Deqübit)
Opened Wounds Due to Circulatory Disorders (Venous Sedge ulcers)
Traumatic Wounds
Unclosed Wounds as a result of surgical procedures
Grafts, flaps
Intraabdominal injuries
Inflammatory wounds with discharge
Wounds That Application Will Not Be Correct:
Unwounded Wounds
The presence of bone inflammation must have received treatment before the start of vacuum treatment
Vascular integrity is at risk.
Wounds with fistula near the breech
What Is The Advantage (advantage) Of Other Wound Treatment Methods.
Reduction of the number of bacteria due to keeping the wound dry
Increased regional blood flow, consequently reduced edema, easier access to active cells in wound healing
Rapid contraction of the wound boundary with narrowing from the edge to the center of the wound Less unwanted scar tissue
Immune return to normal due to effective blood supply to the wound
Shortening of recovery time
Triggering of cell division due to mechanical stress in cells due to variable pressures and increased production of healing tissue
What is the Disadvantage of Other Wound Treatment Methods?
More Costly.
Application should be done by health personnel who require special training.
There are differences in efficiency between the device and sponges depending on the manufacturer.
The device cannot be mobile for a long time due to the need for energy connection.
47AXX
Curad Flex-Fabric Adhesive Bandages with Stretch to Conform to Wounds, 2 x 4 Inches, (50 Count)
