What 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
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
- Sitting or lying on hard objects
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.
can occur from heat, friction, chemicals or tape. Possible
sources of burns include:
- 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
- Sitting on hot objects, such as rocks or concrete in the
- 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
- Slouching in bed or in the wheelchair
- 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
- Worn out or improper equipment
Stages of Pressure Sores