Bedsores, pressure ulcers & wound therapy

Among the problems that negative pressure wound therapy is regularly used to treat, bedsores are one of the most common.  But what are bedsores? How do they develop, how are they treated and how and why is NPWT used to heal them?

In this article, we’ll take a brief look at these injuries, explain how they develop, explore possible complications, and discuss how and why wound vacs are used in healing them.
 

What are bedsores?

Bedsores – also known as pressure ulcers, pressure sores, pressure injuries or decubitus ulcers – are essentially skin, soft tissue and bone injuries that develop due to prolonged pressure on an area of the body. They’re called “bedsores” because they’re often seen in patients who have limited mobility and are confined for long periods of time to a bed or a chair.

Pressure ulcers can also evolve due to friction – for instance, if a patient is lying in bed and the skin has become fragile and moist, it can be rubbed and damaged by sheets or other fabric.

Pressure ulcers can develop quickly, and they appear most often in places where the bone is near the surface of the skin, such as:

• On the lower back or at the base of the spine (tailbone)

• Around the heels or ankles

• On the elbows

• On the hip

• Around shoulder blades

• On the back of the skull

Unfortunately, pressure sores may look small on the surface, but the damage beneath the skin is often much worse. The blood vessels next to the bone get squeezed, so the muscles and the tissues near the bone usually suffer the most. 

Bedsores are common, especially in hospitals and nursing homes, where patients remain in bed for extended periods of time.  In fact, according to a recent report by the National Pressure Ulcer Advisory Panel (NPUAP), approximately 2.5 million patients develop pressure injuries each year, leading to 60,000 deaths per year due to these injuries and related complications.
 

Early warning signs and complications

One of the first signs of bedsores is a change in skin color.  The skin in the affected area usually starts to look red, purple or blue, and then develops an open sore as the wound develops through the skin and tissue below.

As the sore worsens, dead tissue can lead to drainage and fluid leakage, as well as strong odors, and the patient may develop fever. In the worst cases, deep tissue injury, muscle and bone infection, necrosis and even sepsis can result if sores are left untreated.
 

Treatment options

During early stages, it’s important to move the patient and release pressure from the affected area. The infected area should be kept clean and dry, and patients should increase their intake of water and protein to help with blood flow and healing.

Dead tissue must be removed (this process is called debridement) and regular inspection of the area must be completed. Antibiotics – either topical or oral – are often used to help treat infection while the wound is healing, and dressings should be applied and regularly changed.

Treatment of more serious injuries is challenging. If treated quickly and properly with a process such as negative pressure wound therapy, bedsores can heal within a few weeks, but more serious wounds can require surgery.
 

Negative pressure wound therapy (NPWT) and bedsores

The use of negative pressure wound therapy (NPWT) with a wound “vac” (or vacuum-assisted therapy) has proven to be a highly effective option for the treatment of pressure ulcers. During this process, a suction tube is attached over the wound, along with dressings, to:

• Release pressure

• Draw away moisture and remove drainage

• Help close the wound

• Reduce the risk of infection

In short, after the removal of dead tissue, this process takes care of all the necessary requirements for helping the wound heal.

When used properly, negative pressure helps wounds heal within 4-6 weeks at half the cost of surgery. In addition, it removes all surgical risks and potential complications, which is especially important given that nursing home and hospital patients are often poor candidates for pressure injury reconstruction surgeries in the first place.

Have more questions about healing bedsores with wound vacs or NPWT? Contact us today.

Jim Nabors Would Just Cry

by Dr. Michael Miller

For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his always well-received “Back Home in Indiana” as a mantra to that source of pride.  Our former Governor “My Man” Mitch Daniels was a genius who, using a combination of intelligence, common sense and the persuasive powers of a midwest Svengali, created an economic model that our neighbors can only lust after. Our medico-legal climate is among the best in the US and well it should be.

However, while there are some extraordinary caregivers and facilities here, a recent US News and World Report curiously showed that almost none of our hospitals made their “Best of” lists in any category. That is not to say there is bad care, but to not have a single facility in an entire state even achieve an honorable mention gives one pause to reflect. The state newspapers were notoriously quiet on this concerning fact, despite their trumpeting of who does what well, when and where.

To give an insight into why this may have happened, I offer the following. Several years ago, our Department of Health created a pressure ulcer task force initiative designed to establish guidelines, which were intended to improve prevention, treatment and reporting. There was a great hullabaloo from the department and the many entities invited to participate regarded the creation of this work as a pressure ulcer paper messiah.

Of course, you must remember that development of pressure-based tissue injuries that are currently called Stage 3 and Stage 4 are to be reported to CMS as they are now considered NEVER EVENTS.  (Dare I use this moment to prognosticate my next blog discussing the complex, stupid and illogical systems currently used to “Stage” these?) And more, these numbers are to be reported as part of a medical errors reporting system.

There is a generally acknowledged fact that for better or worse, despite the very rare “unpreventable” pressure-based tissue injuries, the development of a pressure ulcer in a hospital is as ubiquitous as Facebook lurkers.  With approximately 200 acute care facilities, even the most optimistic (and deluded) health care professionals I have spoken with offer numbers anywhere from five (5) Stage 3 and 4 pressure-based tissue injuries up to 200 per month. Nobody has suggested fewer and there have actually been some who thought there were more. Simple mathematics, using even the low number, would result in approximately 12,000 bedsores developing right here in the Hoosier State (5 bedsores x 200 hospitals x 12 months). 

And so, to cut to the chase, the most recent report from our Indiana Department of Health for medical errors in 2013 was recently published.  It identified the names and numbers regarding the facilities that honestly disclosed their medical errors (based on mandates with severe, punitive actions for failing to do so). Forty-five bedsores were reported!!  Moreover, the officials in charge of this program were outraged because the prior year, there had been 30 reported, which demonstrated a 50% increase!

At this point, I will pause and allow you to re-hinge your jaw from the unquestionable drop it took. 45 bedsores, a 50% increase from a year prior and a national report on health care performance demonstrating that there may be health care here, but it is probably better almost anywhere else? And so, regardless of the veracity of these numbers, they still mandated action.

Of course, the powers that be plodded explosively into action announcing new programs to improve care. When my children were naughty, they were punished. When they lied about being naughty, the punishment increased. Closing my eyes, plugging my ears and telling my wife that I will be creating initiatives to improve their behavior sounds good, but trying to put a patch on a badly broken and dysfunctional wheel is simple bureaucratic buffoonery.

IS the grass greener on your side of the wound dressing? What is your state up to in terms of pressure ulcer prevention, treatment and reporting? As far as our state song sung with such vim and vigor by Jim …perhaps the title needs to be, “Back home anywhere but Indiana.”

Until we ramble together next time.

Dr. Michael Miller is Board Certified in General Surgery by the American Osteopathic Association and initially received his 10-year certification in wound care by the American Academy of Wound Management in 2000 and the American Professional Wound Care Association in 2005.
 

 

His practice has been devoted exclusively to wound care and related issues since 1998. He is one of very few full-time physician wound care specialists in the State of Indiana, as well as the U.S. He has published numerous articles in peer-reviewed journals, written chapters in wound care texts, and presented poster exhibits and podium presentations at numerous domestic and international conferences.

Dr. Miller is also a consultant to numerous companies in the wound care industry and provides expert consultations to professionals in the investment and legal industries. In addition to his clinical practice, he owns several patents on wound care devices. Dr. Miller was named the American Osteopathic Foundation's 2010 Physician of the Year.