Pressure ulcers, deep wounds, pressure sores, bedsores, pressure wounds - they go by many names, but the discomfort remains the same. While quick to develop, these tissue injuries (which can range from moderate to severe) are relatively simple to treat and the sooner the better, since left untreated, they can lead to many complications like sepsis, cellulitis, bone and joint infection, and in some cases, even cancer.

Left untreated, pressure ulcers can lead to many complications like sepsis, cellulitis, bone and joint infection, and in some cases, even cancer.

What Causes Pressure Ulcers?

There are many causes and contributors to pressure ulcers. At the most basic level these ulcers result from three primary contributing factors:

• Sustained pressure. When skin and the underlying tissues experience prolonged contact against a surface such as a wheelchair or a bed, the pressure may be greater than the pressure of the blood flow. This prevents vessels from delivering oxygen and other nutrients to nourish the body’s tissues and without these, skin cells are damaged and eventually die. This happens most often to areas that lack sufficient padding from muscle or fat, areas like heels, hips, shoulder blades, elbows, and the tailbone.
• Friction. Friction occurs when skin is dragged across a surface. In the case of a patient, this can happen when they change position or a care provider moves them. Friction is exacerbated when skin is moist, making fragile skin more vulnerable to injury.
• Shear. Shear occurs when two surfaces move in the opposite direction; for example, when a hospital bed is elevated, a patient may slide down, pulling the bones and the skin in different directions. On bony areas, this may cause oppositional pulling, injuring tissue and blood vessels, making the area more vulnerable to damage.

While these are the mechanics of pressure ulcers, it’s also important to know the conditions that may put a patient at increased risk. According to a study published in Age and Ageing, the following conditions may contribute to the likelihood of developing pressure ulcers:

• Alzheimer’s disease
• Congestive heart failure
• Chronic obstructive pulmonary disease
• Cerebral vascular accident
• Diabetes mellitus
• Deep venous thrombosis
• Hip fracture or surgery
• Limb paralysis
• Malnutrition
• Osteoporosis
• Parkinson’s disease
• Rheumatoid arthritis
• Urinary tract infections

A Surprising Finding

It may surprise you to discover, however, that there are some conditions that enjoy an inverse relationship to pressure ulcers; in other words, when these maladies are present, the incidence of pressure ulcers decreases. The Age and Ageing study revealed that one of these conditions is hypertension.

Hypertension and Wound Healing

There is conflicting research on the subject of hypertension and pressure wounds. Some studies purport that patients with hypertension may experience lower rates of pressure ulcers. However, others state that hypertension reduces oxygen flow, which is essential for healing wounds. Let’s examine both sides of the argument.

Does Hypertension help?

What the doctors at the University of Pennsylvania School of Medicine and the University of Maryland concluded in their study was that the presence of high blood pressure and a reduced rate of pressure ulcers in patients could be caused by the medicine used to treat the disease in the first place.

“Another plausible explanation for why these patients were less likely to develop a pressure ulcer is that the medications that these patients received as a consequence of having one of these illnesses prevented the onset of a pressure ulcer.”

In other words, it was not hypertension itself that helped prevent or heal the wounds, but the medication used to treat hypertension.

Does Hypertension hinder?

It’s commonly accepted within the medical realm that for wounds to heal, they need a good blood supply, and any condition that impairs circulation and oxygenation will inhibit the healing process. High blood pressure (along with advanced age, diabetes, anemia, chronic lung disease, even tobacco use) fits the bill.

THE FINAL WORD

As with most things in life, it’s difficult to draw a conclusion with complete certainty as to just how hypertension affects pressure wounds, but we can be sure that, in order to function optimally and repair as necessary, the body requires good blood flow and oxygenation, so on the whole, hypertension is not a desirable condition under any circumstance.

Treatment of Pressure Ulcers

Whatever the cause, once developed, the question becomes, how can we treat pressure ulcers? Treatment typically requires a multidisciplinary approach and can include the following:

• Reduce the pressure, either through a regular repositioning of the patient or the use of support surfaces like those available at Wound Care Solutions that will allow a patient to rest in the appropriate position.
• Clean and dress the wounds on a regular basis to prevent infection.
• Remove damaged tissue. Depending on the severity of the pressure wounds removal of the damaged tissue (debridement) may be necessary to aid in recovery. Debridement can take several forms including surgical, mechanical, autolytic, or enzymatic.
• Try antibiotics. Infected sores that aren't responding to other interventions may be treated with topical or oral antibiotics.
• Change your diet or add dietary supplements that may promote healing.
• In extreme cases, surgery may be necessary to treat pressure wounds that won’t heal.

Prevention of Pressure Ulcers

As for prevention, there are many things individuals can do to prevent the risk of both hypertension and pressure wounds:

To reduce the risk of hypertension.

• Lose weight. Losing as little as 10 lbs. may help lower blood pressure.
• Drink plenty of water.
• Eat healthy foods. Eliminate fast food and eat foods high in fiber and rich in potassium.
• Get active. Even something as simple as going for a walk has been proven to lower blood pressure.  
• Quit smoking. Nicotine temporarily increases blood pressure and heart rate with each use.
• Drink less alcohol. Alcohol increases blood pressure. Drink in moderation, or eliminate alcohol altogether.
• Cut back on salt. Replace with flavourful spices to keep taste buds satisfied.
• Manage stress through relaxation techniques like meditation, yoga, and walking.

To reduce the risk of pressure wounds.

If you are confined to a bed or a wheelchair for a long period of time, the following tips may help reduce the risk of developing ulcers and bedsores.

• Change positions frequently, putting less pressure on the skin, reducing the risk of developing pressure ulcers. Reposition every couple of hours. Enlist a family member or caregiver to help if necessary.
• Keep skin clean and dry. The cleaner and drier the skin, the less likely it will develop bedsores. After washing, always pat skin dry with a towel. Do not rub.
• Use a support surface between parts of the body that press against each other or against a surface like a wheelchair or a mattress. Wound Care Solutions provides support surfaces for patients, paid for by Medicare and most private insurances, to patients who have limited mobility in order to prevent pressure ulcers.
• Exercise. Even for patients who can’t get out of bed, simple exercise and range of motion activities can help reduce the risk of bedsores.

For more information on medical equipment and products that can help address pressure wounds, and documentation of medical necessity required to access them, visit Wound Care Solutions and discover our range of durable medical equipment.