In this blog, we take a look at what a pressure sore is, how one develops and how they can be avoided.
What is a pressure sore?
A pressure sore is an area of skin or underlying tissue that becomes damaged due to a loss of blood flow to the affected area. If an area of skin does not receive adequate blood flow to keep it healthy, it will die and leave a sore.
Pressure sore damage can range from a mild reddening of the skin to severe complications involving bone and blood infections that can be very difficult to treat and slow to heal.
How Are Pressure Sores Caused?
Pressure sores are primarily caused by prolonged and excessive pressure on an area of skin.
Sitting or lying in one position for too long without relief is the most common cause of pressure sores for people with spinal-cord injuries (SCI). Such extended pressure restricts or cuts off blood flow to the affected area, leading to skin breakdown, tissue damage and pressure sores.
Pressure sores can also be caused by cuts and grazes, prolonged pressure from medical equipment such as catheter connectors or external fixators, and friction, or what is known as ‘shearing.’
Shearing occurs when an area of skin and the bone underneath move in opposite directions causing tissue to slide over tissue. This can happen when you slouch whilst sitting or if you attempt to slide rather than lift your body during, for example, a transfer. Sores can also occur from just lying on mattress seams or buttons for too long.
Why Are People with Spinal Cord Injuries More Susceptible to Pressure Sores?
People with undamaged spinal cords are able to feel pain or irritation when an area of skin becomes uncomfortable due to restricted blood flow. Spinal cord-injured people, however, may not have the same level of function in their sensory nerves.
Put simply, this means you may not be aware of the need to shift your body position to relieve prolonged pressure on certain parts of your body. This can cause pressure sores.
Due to your SCI, you may have less muscle mass, meaning there is less natural cushioning and protection over bony areas of your body. You may also suffer from poor circulation as paralysed limbs will naturally receive less blood flow due to their lack of muscle movement. This means that skin starved of the nutrients and oxygen normally used to nourish healthy skin, is less able to heal itself.
Poor circulation will also lead to fluid retention in areas of tissue that remain static due to paralysis. Skin covering these areas will become pale and thin and will injure easily.
Spasticity - a side effect of paralysis involving the involuntary contracting or tightening of muscles - can cause your limbs to bump or rub against objects unknowingly, leading to the development of sores.
How Can I Prevent Pressure Sores?
Pressure sores are entirely preventable. Regularly moving and changing your body position are the most effective ways of preventing pressure sores. This is particularly important at night. A regular nocturnal turning schedule is as important as ensuring you use pillows, mattresses and cushions that have the sufficient padding you need to protect your bony areas.
Spreading your body weight and using pressure-relieving devices and supports are also an effective way of preventing pressure sores. These can include special foam overlays for mattresses or supports and bed coverings that can be filled periodically with air, water or beads to relieve pressure and help distribute your body weight evenly.
If using your wheelchair, it is important that you have adequate padding to reduce pressure and friction, you avoid slouching, and you perform pressure reliefs every 15 to 30 minutes. You should do these for at least 30 seconds.
When transferring in and out of your wheelchair, you should do your best to avoid dragging or bumping yourself, and if you are unable to lift yourself unaided, you should instruct your care giver to ensure you are regularly moved. If you are bedbound, it is important you change position at least once every two hours.
Daily skin care is crucial and it is important you keep your skin moisturised as well as clean and dry from incontinence or sweat. People with SCIs should check their skin at least twice a day and pay particular attention to any changes in skin colour, blisters or bruises, or evidence of cracked, damaged or dry skin. Areas that need special attention include - elbows and knees, ankles and toes, the tailbone, sacrum, and the back of the head. It is important to check for any swelling or hardening of the skin that may indicate skin breakdown.
Clothing and shoes play a prominent role in ensuring you avoid pressure sores too. Clothing must not only be easy to put on and wear but it must also be properly fitted and free from bulky zips, buttons and rivets. Shoes and slippers should be wide-fitting and adjustable to allow for swelling and they should also have adequate toe protection to prevent damage caused by bumps and scrapes.
Finally, nutrition - eating a balanced diet will provide your body with sufficient amounts of protein, vitamins and minerals to help prevent skin damage and keep tissue healthy and able to easily repair itself. Although it is obviously important to ensure you drink enough fluids, your water intake may vary according to your bladder management routine.
Jonathan Fogerty is an associate solicitor specialising in spinal cord injury claims at Slater and Gordon Lawyers. Jonathan lives with the effects of his own spinal-cord injury which was caused as a teenager when he dived into a swimming pool.
"For me, one of the biggest areas of concern for those affected by spinal-cord injury is skin and maintaining skin integrity. A serious pressure sore can take anything between two and three years to heal and so the emphasis should continually be on avoiding pressure sores.
“Remember that once skin has been affected by a sore, its ability to withstand pressure is substantially reduced and so a serious pressure sore could really impact upon somebody's ability to sit for any reasonable period of time. This can affect their ability to work, travel or function on a day-to-day basis.”
The Slater and Gordon spinal injuries team has access to a network of treatment providers and medical experts with a vast range of experience in helping people who have suffered serious injuries. We can arrange medical treatment, physiotherapy, counselling, retraining, re-housing and many other rehabilitation services. Whatever the nature and extent of your injuries, we will make sure you are in the very best hands.
Slater and Gordon are proud to be a Ruby Corporate Sponsor of the Spinal Injuries Association, the leading national charity for spinal cord injured people and their families.
For a free consultation, call us on freephone 0800 916 9046 or contact us online and we will call you.