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Decubitus Care (Bedsore Management)

Things you should know before considering an anti-bedsore system :


Bedsores are wounds that result from skin breakdown caused by poor circulation. This can happen to anyone who remains immobile for extended periods of time with weight bearing parts of the body exposed to such risk. Even healthy individuals feel an ache when they sit in the same position for too long and will shift their weight around to relief the discomfort. Older, immobile patients will not be able to do that and their poor sensory function may also not alert them to any tissue damage resulting from their immobility until it is too late.



Common Location of Pressure Sores            Anatomy of the Skin



Click here to learn about the factors Effecting Pressure Sores


Click here to learn about the Braden Scoring System



Stages of Skin Breakdown


1) First Stage Ulcers





This can occur within 2 hours of immobility and the usual areas of risk include the sacral region, shoulders, heels, and other boney prominences.

Symptoms include reddening at first and then darkenng of the skin before skin breakdown occurs.




Unbroken sking should be moisturised to enhance self healing and the pressure must be relieved to avoid worsening. If the skin is already broken, an antispetic may be applied for a day or two to stem any possible infection not compulsry). Broken skin should always be covered with a sterile covering, preferably with a semi-permeable, waterproof membrane dressing that keeps the wound clean and free of contamination. These wounds are fairly easy to manage with pressure relief being key and should resolve within a week. 


2) Second Stage Ulcer





Once the skin breaks down int the dermis layer, the chances of infection are greater. Open wounds that are left unattended become ideal hosts for bacteria and this may be made worse if comtaminants exists, as in the case of bowel or urine contaminants in sacral wounds. The infected tissue may become yellow and develop into a crater as the wound worsens. The depth of the wound extends down through the dermis and should be atteneded to immediately to avoid worsening.




Second stage wounds are usully quite clean at the onest and worsen progressively. In the early stages, keeping the wound clean and protected is the objective. After wound cleaning, a sterile dressing, as described above, may be instituted.


For wounds that have presisted and also present with an odour is indicative of an infection. These wounds are best treated with Vacutex, a capillary dressing that actively cleans the wound whilst maintaining a moist and continuosly nourished wound bed. With Vacutex, the wound should be left covered with a waterproof transparent dressing and not disturbed but checked on routinely for several days. The dressing should be changed when found moistened.


If a rapid capillary dressing is unavailable, an antispetic can be applied each time to clean the wound before dressing with a sterile waterproof semi-permeable membrane as covering. The wound should be monitored and cleaned daily with this management technique. 


3) Third Stage Ulcers







Ulcers of this category are far more serious and involves wounds that have worsened by more significant tissue erosion into the subcutaenous layer. Wounds of this nature usually also manifest slough (yellow dead tissue) and necrosis (black, hardened and dried tissues). These wounds  are considered serious wounds. Wounds like these tend to be weepy and may also manifest sinus tracking (small deep holes that go in deeper and are harder to reach for cleaning). At times, there may also be a margin (shelving) which is basically the upper skin having a deep recess that runs throughout the perimeter of the wound and again is difficult to clean and manage.


3rd stage wounds can quikly deteriorate into 4th satge ulcers and need aggressive management.




The objective of managing these wounds is to restore good blood flow to the wound bed whilst keeping the wound itself clean. The wound may have to be cleaned of slough or nerotic tissue and be heavily exudatng. Exudates tend to moisten the wound with dysfunctional fluid which rarely carries nutrients, hence this is best removed.


Vacutex will deal with the various aspects of a complex wound simultaneously. This helps users save cost and reduces the complexity of knwoing what products to use when. Apply Vacutex, by cutting it and conforming the application to sit well on the wound. Several layers may be used and then the wound should be covered with a sterile waterproof dressing. Again, the dressing is changed only when it is wet.


A good pressure relieving mattress should be used to manage the skin pressures optimally. 



4) 4th Stage Wounds





These are the most dangerous wounds because they are represented by the wound tissue having been eaten away until the bone or cartilage is exposed. The wounds are usually very deep, weepy and may also be very sloughy or necrotic. The chances of serious infection setting in and spreading into the blood (septicemia) is also there. Fatalities are known to occur amongst those with 4th stage ulcers because of infection.





Clinical managment is required. Special mattresses will be neede to help manage this complex wound



Talk to the Trident team to help you understand the required steps to achieve optimal care for your patient. We will perform ward or house calls to ascertain the patient's condition and recommend a suitable care plan.


Our areas of coverage include :


  • Wound Assessment
  • Woundcare Plan and Supplies
  • Risk Assessment with Braden Scoring
  • Product recommendation and Supply
  • Nursing Support



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