Decubitus Ulcers or Pressure Ulcers: What Are They?

Decubitus ulcers or pressure ulcers, more commonly known as bedsores, are open wounds on your skin due to the prolonged pressure applied to the area. These ulcers occur mostly over the bony prominences such as the hips, tailbone, ankle, and heels. Bedsores are a frequent condition experienced by those who are immobilized or unable to change their positions and patients who are bedbound for a long time. 

What are decubitus ulcers?

Decubitus ulcers have been given several names. They are also called as pressure ulcers, pressure sores, or bedsores. However, the best term to be used is pressure sores. Pressure sores are open wounds due to a continuous pressure on the skin. The sores are the result of skin and tissue damage.

The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressurein combination with shear.

Pressure sores are more likely to occur among:

• elderly people
• bedridden people
• people who spend most of their time on the bed or wheelchair
• people who are dependent on others to move certain body parts such as those who are paralyzed from hip down
• people with fragile skin

Pressure ulcers may develop very quickly in an individual and often are difficult to treat. However, the condition is treatable and if it is diagnosed early in the disease course, the patient may likely have a very good recovery.

The Four Stages of Decubitus or Pressure Ulcers

The National Pressure Ulcer Advisory Panel (NPUAP), a professional authority that targets to improve the patient outcomes in pressure injury prevention and treatment, has developed a staging process to help doctors diagnose and treat such condition. 

Stage 1

Stage 1 is the earliest stage in the development of a pressure ulcer. It is characterized by the following features:

• The skin is not broken.
• In fair people, the affected area appears red in color and does not blanch on pressure, which means that the redness does not disappear when pressure is applied over that area.
• In dark-skinned people, there is a discoloration in the affected area that varies from blue to purple. They do not blanch on pressure as well.
• The affected area of skin will be painful, tender to touch, firm, soft, warm, or cool in contrast to the surrounding skin.

Stage 2

In stage 2, the following characteristics may be noted: 

• The superficial skin (epidermis) and sometimes the underlying skin (dermis) are broken or damaged.
• The wound appears shallow with a pink or red color wound bed.
• It may appear as a fluid-filled blister or a ruptured blister.

Stage 3

When it comes to stage 3 of the disease, the ulcer has progressed to a deep wound and it may bear the following characteristics:

• The skin exposes the underlying fat layer.
• The skin develops an open hole resembling a crater.
• The floor of the wound may have yellowish colored pus with dead tissues.

Stage 4

By the time the pressure ulcer reaches stage 4, several layers of the tissue will be affected. The wound is much more extensive than before and is characterized by the following features:

• The ulcer exposes the underlying muscle, bone, or tendons.
• The floor of the ulcer is occupied by dead tissues that appear as yellowish, dark, and crusty. They are known as "eschar."

Unstageable

The pressure ulcer cannot be staged if the wound is covered with yellow, brown, black, or dead tissues as the depth of the wound cannot be determined.

What are the causes of decubitus or pressure ulcers?

As the name suggests, the main underlying cause of pressure ulcers is the continuous pressure on the skin. When a continuous pressure is applied to the skin for a long period of time, then the skin can get damaged and an ulcer develops. The skin overlying a bony prominence such as the tailbone, hips, ankles, and heels is very thin, and therefore, is more prone to pressure ulcers.

Pressure ulcers can also result when your skin is rubbed against a hard or rough surface. The friction that is produced as a result of the rubbing may damage the overlying skin.

What are the signs and symptoms of pressure ulcers?

The signs and symptoms will vary according to the stage of the ulcer. Depending on which stage your ulcer is in, you can experience any of the following symptoms:

• discoloration of the skin
• pain
• intact or damaged skin
• the affected area of the skin does not blanch on pressure
• crater-like wound with yellow colored pus covering the floor of the wound
• pink or red wound
• the skin may appear soft, firm, warm, or cold in contrast to the surrounding normal skin

How are pressure ulcers diagnosed?

The diagnosis of a decubitus or pressure ulcer solely depends on the external examination of the wound. The following features will help your doctor in diagnosing and staging the ulcer:

• The depth of the wound.
• The type of tissue that is affected such as your skin, muscle, bone, or tendon.
• The color of the ulcer.
• The amount of dead tissue present in the ulcer.
• The current condition of the ulcer in association with bleeding, foul smell, or an infection.

Your doctor may take samples of fluid and cells from the ulcer for further investigations to exclude more dangerous conditions such as cancer.

How are pressure ulcers treated?

Just like in diagnosing a pressure ulcer, the treatment will also depend on the stage of your ulcer. There are several treatment options available including medicine, therapies, and surgeries.

1. Your doctor may prescribe antibiotics and painkillers to treat the infection and reduce the pain, respectively.
2. The surgical procedure known as "debridement" is done to clean your wound and remove all the dead tissues.
3. It is important to keep the wound clean to avoid infections and promote healing. For this reason, your doctor may ask you to frequently change the dressings on your wound.
4. Maintain a healthy diet and drink more fluids for a faster recovery.

The outcome of the condition depends a lot on the stage of your ulcer. If an early diagnosis was made before stage 3, then treatment would be less difficult.