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Spinal-Injury.net :  Pressure Sores and SCI

 
  Pressure Sores

Unwanted pressure on skin - causes this damageWhat are Pressure Sores? Skin pressure sores are the most common and devastating medical complication of spinal cord injury. Also called pressure sores, decubiti, decubitus ulcers, or bedsores, skin sores are more apt to occur after SCI due to lack of movement and sensation and to changes in circulation.  The social impact of skin problems far outweighs almost all other problems you may encounter. A skin sore can mean several weeks of hospitalization or bed rest in order for the sore to heal. This can mean valuable time away from your job or school.

The most important point, however, is that skin problems are preventable. By eliminating the causes of skin sores and with routine inspection of your skin, skin sores need not happen. You must be responsible for your skin care. You must know the condition of your skin and the early warning signs of skin sores. Skin management cannot be neglected. Skin management is of vital importance to you and your continued ability to function.

What Causes Pressure Sores? Because your blood flows more slowly after SCI, your healing ability is reduced. In addition, your skin cannot tolerate as much pressure as before. Your skin can now tolerate a minute amount of pressure for a long time, but it can only tolerate great pressure for a short time before the circulatory system is disrupted and a pressure or skin sore results.

The decrease in circulation and lower tolerance for pressure is further aggravated by the lack of sensation after SCI. This lack of sensation means there is no longer a feedback mechanism to tell you that there is a problem - that you have been sitting too long without moving or that you have injured yourself, for example.

The major causes of skin sores are:

  • Prolonged pressure
  • Bruises or scrapes
  • Prolonged wetness on the skin
  • Burns
  • Sitting or lying on hard objects
  • Frostbite

progression of a pressure soreProlonged Pressure: Prolonged pressure means you sit or lie in the same position long enough to cause symptoms of skin damage. These symptoms can also be caused by any clothing, braces, or hard objects that put pressure on your skin. The first symptom - your warning signal - is a reddened area of the skin. No damage has occurred if you remove the pressure and the redness fades with 15 minutes after the pressure is removed.

 Skin damage from pressure usually begins over bony prominences - any place on the body where the bones are close to the skin surface, such as the hip. Bony prominences tend to put pressure on the skin from within. If there is a firm surface on the outside as well, the skin will be pinched between the firm inside bone and the firm outside surface, resulting in a lack of circulation.

Due to the decrease in the rate of circulation that occurs following SCI, there is also less oxygen to the skin. This contributes to a lowering of the skin's resistance. If the skin is deprived of oxygen due to pressure, the body will try to compensate by sending more blood to the area. This may result in swelling, which will put even further pressure on the blood vessels and further block circulation.

You have seen the impression left on a carpet after a chair was moved, and you know that the carpet will get a hole in it if the chair is not moved every so often. This same process happens a lot faster in people than in carpets. Pressure forces blood out of the tiny blood vessels, which nourish the skin and the tissue under the skin. The pressure is most likely to cause damage over bony parts of your body.

Bruises or Scrapes: Bruises or scrapes can occur as a result of a bump or fall. Other causes are ramming your feet into doors or walls or dragging your buttocks while transferring. Because of the lack or decrease of sensation, you may not realize that an injury has occurred. Because of the changes in your circulatory system, you will not heal as quickly and a skin sore may develop.

Prolonged Wetness On The Skin: Possible sources of wetness are perspiration, stool or urine. Moisture of any kind can cause chafing, or excoriation, of the skin. Plasters or Band-Aids may also cause an excessive accumulation of moisture under the protected area. Moisture prolongs the healing process. Prolonged wetness can lead to a loss of layers of skin which may result in a skin sore.

Burns: Burns can occur from heat, friction, chemicals or tape. Possible sources of burns include:

  • Sunburn
  • Hot water, as in a bathtub or shower
  • Hot water pipes
  • Carrying hot foods or placing liquids on your lap
  • Kitchen stove during the cooking process
  • Picking up or touching hot foods or drinks, such as pizza or fried chicken
  • Electrical appliances, such as hair dryers or irons
  • Electric blankets, hot water bottles or heating pads
  • Sunlamps
  • Cigarettes
  • Sitting on hot objects, such as rocks or concrete in the sun
  • Hot pavement
  • Automobile mufflers, tailpipe, exhaust, heater vents that are directed at the feet, seatbelts, steering wheel, upholstery, or any object that can get hot in a car.

Friction burns can occur when surfaces rub against a hard surface, i.e. from spasm or sitting in bed at a 45-degree angle. Some chemicals, such as disinfectants, can cause burns, and adhesive tape can also cause burns (use the non-allergic type), "paper tape".

Sitting Or Lying On Hard Objects: Sitting or lying on a hard object can cause a skin sore. Possible sources are:

  • Safety pins
  • Buttons on mattresses
  • Buttons on jeans or trousers
  • Bulky seams
  • Objects placed in trousers' pocket
  • Catheter connectors
  • Catheter clamps
  • Tight clothing over catheter tubing


Frostbite: Frostbite can occur as a result of exposure to a cold environment without enough protection. Always dress warmly if you are going to be outside in cold weather. Ice packs are also a source of frostbite if they are not used properly.


Other Things That Increase Your Chance of Getting a Pressure or Skin Sore:

  • Skin wet from sweat, urine or stool
  • Poor nutrition causing anaemia (low blood count) and low protein
  • Slouching in bed or in the wheelchair
  • Fevers
  • Bumps or other injuries to the skin
  • Friction to the skin, caused by sliding or being pulled across a surface, or by spasms
  • Clothing, braces, splints, etc., that are too tight
  • Forgetting or neglecting to take care of yourself if feeling depressed or when drinking too much alcohol or abusing drugs
  • Worn out or improper equipment

Pressure Sores
Stages of Pressure Sores
Reapplying Pressure
Skin Management
Prevention Tips
 


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