Bedsores, or pressure ulcers, can develop when a person is seated in the same position for an extended period on a bed or wheelchair. These bedsores usually develop on one or both sides of the ischial bone. Typically, one side of the sore is deep, while the other side is superficial. The location of bedsores depends on the patient’s position:
Other common areas for bedsores include the heel, elbow, malleolus (ankle), knee, scapula (shoulder blade), and occiput (back of the head).
Ischial bed sores typically occur in individuals with paraplegia due to spine injuries that affect the lower half of the body, leading to a lack of mobility. People who are very sick and unable to move due to primary ailments like paralysis, trauma, fractures, or old age are also at risk. These conditions confine the patient to a bed or wheelchair in an upright or sitting position for an extended period, making them susceptible to developing bedsores.
Bedsores are categorized based on the extent of damage:
Regardless of the stage, relatives or attendants are advised to consult a plastic surgeon immediately to prevent further progression.
Patients with Category I or II ischial bed sores may not require admission if other comorbidities and factors are well controlled. They are educated about wound management, and specific dressings are advised. Follow-up is typically scheduled every week initially, and later, once or twice a month for three months after complete healing.
Patients with Category III or IV ischial bed sores require hospital admission. A comprehensive evaluation of their nutritional status and surgical fitness is conducted. After admission, a pre-anesthetic checkup is performed. Clearances from specialists, such as neurologists, cardiologists, and physicians, are obtained to ensure surgical fitness. Once the patient is vitally stable and medically cleared, surgical correction is planned.
In cases where the wound is severely infected and requires further debridement or the patient is too ill to undergo flap coverage in the same sitting, two-stage surgery may be considered. In the first stage, debridement is performed, and Negative Pressure Wound Therapy (VAC) is applied for 5-7 days. After approximately a week, the VAC is removed. If there are no signs of active infection and the patient’s condition has improved, a flap cover surgery is planned for the second stage.
Patients receive instructions for home care, including the use of an air mattress, hygiene practices, and regular side-to-side turning. Follow-up visits are scheduled after one week and later once or twice a month as needed.
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Bedsore Development, also known as pressure ulcers, occurs when sustained pressure on the skin and underlying tissues restricts blood flow. This often happens when individuals remain in the same position for prolonged periods, such as in a bed or wheelchair.
Common areas include bony prominences like the sacrum, heels, and hips. These areas are susceptible to pressure ulcers because they bear most of the body’s weight, leading to decreased blood circulation and tissue damage.
Risk factors include immobility, reduced sensation, moisture, poor nutrition, and advanced age. Mitigating these risks involves regular repositioning, maintaining skin hygiene, and proper nutrition.
Early signs may include redness, skin warmth, or discomfort. Regular skin checks and proactive measures, such as changing positions and using support surfaces, can help prevent progression.
Preventive measures include repositioning, using support surfaces, maintaining skin cleanliness, optimizing nutrition, and promoting mobility when possible.
Staging involves classifying pressure ulcers into different categories based on their depth and tissue involvement. Healthcare professionals play a crucial role in assessment, prevention, and treatment.
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