Decubituses

Short characteristic of a disease

Decubituses are the damaged sites of skin which arise owing to squeezing of fabrics at long contact with a firm surface (a bed, a wheelchair, the tire, etc.). Decubituses develop as a result of desalination and necrosis of fabrics in the place of a prelum of skin.

Origins of decubituses

It is known that food and saturation of skin oxygen occurs thanks to existence of blood vessels in it. The smallest of them, under the name capillaries, get into each centimeter of skin and feed it. At long squeezing vessels are pressed, and blood does not arrive. It leads to the fact that certain sites of skin are dehematized, and there comes the necrosis of fabrics.

One more their reasons of formation of decubituses the shift of upper layers of skin is. It occurs when the patient is tried to be pulled on a bed, or extend them under him the vessel or wet linen. All this can lead to blood supply disturbance therefore decubituses are formed.

Risk factors of developing of decubituses

People who have the excess weight or, on the contrary, exhaustion are most subject to developing of decubituses, badly eat and drink a little, have a diabetes mellitus or heart diseases in the anamnesis, sweat much, have injuries of a head and spinal cord, suffer from an incontience of urine and a calla. Dirty skin, folds and seams on beds, existence of crumbs and small objects, and also an allergy to care products for skin are considered as also adverse factors.

Places of formation of decubituses

Body parts over bone ledges which adjoin to a firm surface are most subject to formation of decubituses. It is explained by almost total absence in these places of a hypodermic fatty tissue which is capable to reduce pressure upon fabrics.

If the person a long time lies on spin, then decubituses are formed on a sacrum, sciatic hillocks, shovels, a nape, heels and elbows.

When lying on one side decubituses are formed on hips in the field of a big spit, on a lap and anklebones.

Long situation on a stomach leads to formation of a necrosis on a pubis and cheekbones.

Severity of decubituses

Depending on severity decubituses are divided into six stages:

The I stage – occurs reddening of the squeezed sites of skin;

The II stage - skin swells, becomes covered by bubbles, the necrosis (dying off) of an upper layer of skin begins;

The III stage - on skin ulcers develop;

The IV stage - ulcers expand and get into a muscular layer;

The V stage - occurs necrosis and destruction of muscles;

The VI stage – the heaviest stage, an ulcer reaches a bone which can be damaged and infected.

Prevention of decubituses

Prevention of decubituses includes a number of the actions directed to reduction of squeezing of fabrics and preservation of normal blood circulation in skin.

Careful leaving is of great importance for bed patients. For reduction of a prelum of fabrics by the bed patient it is necessary to get a soft and elastic mattress. On sale there is a special mattress from decubituses which has effect of massage, improving blood circulation in certain sites of skin. It is also possible to use a porolonovy mattress if you have no opportunity to get a mattress from decubituses. It is necessary to change as often as possible position of a body of the patient, and to do it it is necessary rather accurately to avoid friction and the shift of soft tissues. The bed of the patient has to be equal and pure, without crumbs and foreign objects. Under body parts where usually there are decubituses, it is necessary to enclose rollers or soft small pillows from foam rubber. Under a sacrum it is possible to enclose a special rubber circle. All these devices (rollers, a mattress from decubituses) increase the area of a body which adjoins to a surface on which there is a patient. It considerably improves blood circulation in fabrics and reduces risk of emergence of decubituses.

Prevention of decubituses also includes the correct and careful turning of the patient, with the minimum risk of damage and friction of soft tissues. If you cannot cope alone, look for the assistant. It is not necessary to pull out and pull wet linen and sheets from under the patient, in the beginning it is necessary to raise him. All manipulations on care of skin and bedding have to be carried out carefully and gently.

For reduction of irritation of skin use soft linen (the more washings, the bed is softer) without seams, patches and buttons. For a toilet of skin use soft low allergy cosmetics. You carry out more often a toilet of generative organs and a crotch as urine and kcal have property to irritate skin. Provide optimum temperature condition in the room, cover and dress the patient depending on temperature, without allowing overheating. Sweat irritates skin and increases risk of developing of ulcers.

The correct care of skin is one of prophylactics of decubituses. Do not assume that skin was too wet or dry, you watch its purity. Use moistening and nutritious cream, the powders drying ointments. Do not rub skin when washing and the patient's wipe, and easily get wet. Sponges and basts have to be soft. At an incontience of urine use pampers or urinals (for men).

Treatment of decubituses

No decubituses medicine will help to fix completely a problem until squeezing of fabrics is eliminated. The main treatment of decubituses has to be directed to recovery of blood circulation in the damaged fabrics. For this purpose use all measures for prevention of decubituses.

For rejection of numb fabrics use various decubituses medicines. Iruxolum ointment has good effect. For more bystry wound repair it is necessary to use the gauze bandages impregnated with vaseline. It is possible to put special hydrocolloid bandages if you have an opportunity to buy them (they rather expensive). Also there are special healing decubituses medicines, in the form of various ointments. It is possible to use sea-buckthorn oil. At development of consecutive infection that often happens when developing decubituses, it is necessary to use antibacterial agents.

Treatment of decubituses which have the big area and difficult heal, make only in the surgical way (change of fabrics).