WHAT THE HECK IS A DECUBITUS?

Decubitus or pressure ulcers are more commonly known as bedsores. Whether you have or have not yet had experience with this problem there are facts you should know to help prevent sores from developing. They are easier to prevent than to treat.

 interview with a specialist

Daniel J. Bonomo, MD, CWS is a Board Certified Mobile Wound Care Physician.  Yes, he's a specialist who actually makes house-calls!

Christopher

Thank you for agreeing to this interview for my blog.  Maybe we can be of some help to my readers.  Let's begin with "what is a bedsore?".

Dr. B.

A pressure ulcer is a lesion of the skin due to sustained, unrelieved pressure.  They are usually on a bony prominence which causes a break in the skin.  They're very difficult to heal.

Christopher

Where do they occur?

Dr. B.

They can happen to any part of the body but sacral [tail bone]is most common then scapula [shoulder blade], hips and feet but anywhere that there is prolonged contact pressure.

Christopher

Are there common contributing factors?

Dr. B.

Yes.  There are several factors.  Nutrition, contact with urine or feces are both factors but remaining in a position for a period of time is the most dangerous.

Christopher

What is the general course of treatment after a sore has developed?

Dr. B.

Debridement*, cleaning the wound to prevent infection, protection, maintaining moisture balance [not too wet, not too dry] and bandaging.  Most important is to keep pressure off the wound because the main reason that the wound happens is pressure so you want to make sure that you remove that one offense.

*Debridement: The act of debriding (removing dead, contaminated or adherent tissue or foreign material)

according to medicine.net

Christopher

What are the mistakes that people make?

Dr. B.

The most important mistake is not realizing how fast a wound can develop. A wound can develop in less that two hours of direct pressure from sitting in a wheelchair or lying in bed where there is pressure on one of those bony prominences where there is very little padding of fat, skin or muscle.

Christopher

Besides being away of pressure points what else can we do to help prevent a wound from developing?

Dr. B.

Nutrition is very important.  Where there is malnutrition, which is very common in the elderly, a would is 10 times more likely [because]the skin becomes thin and there is no fat to cushion.  Without proper nutrition the skin can't grow.  Protein is how the skin stays intact so we recommend a high protein / high calorie diet.

Christopher

What about nutritional supplements? 

Dr. B.

Yes.  Whey protein supplement twice a day.  Also Vitamin C [500 mg/twice a day] and zInc sulfate [50 mg/once a day].

Christopher

Thank you for sharing your knowledge with us.

I have been dealing with this problem for over two years.  My mother returned home from a short hospital stay with a sore on her tailbone.  With all the attention of Dr. Bonoma, wound care nurses and me the sore is, at best, managed.  At times it looks as though the sore is going to completely heal and then without warning opens again.  There is a weekly visit from the good doctor and I tend to the wound daily.  

Some information that we didn't get to in the interview is more detail on preventing pressure points.  They are not restricted to skin against chair or mattress.  In fact you have to be very careful of skin to skin points of contact.  This is accomplished with small pillows between the knees and ankles and anywhere else there might be a problem depending on the patients position.  Also, you have to make sure the bed-bound person is turned, frequently, from side to side to side.  This is usually done on a 2 hour schedule but you need to discuss this with your health care provider.

We are lucky enough to have a special computer controlled air mattress which provides comfort and cushioning.  It also mechanically turns my mother by inflating and deflating air chambers.  This high tech mattress is a help but does not replace repositioning by hand.