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Spinal-Injury.net :  Skin Management + SCI

 
  Skin Management
Pressure sores are one of the worst potential complications of a spinal cord injury.  However with appropriate skin management techniques you can prevent them.

In order to prevent skin sores, you must:
  • Check your whole body frequently
  • Relieve skin pressure
  • Take routine care of your skin

Check your whole body, but pay special attention to bony areas: By inspecting your skin regularly, you can spot a problem at the very beginning. Checking your skin is your responsibility and the way to spot the warning signals of a problem. Don't just ask someone else how your skin looks. If you need someone to help you check, you must be able to tell him or her what to look for.

How Often? At least twice daily. Morning and evening when dressing or undressing are recommended.

Check more frequently if you are increasing sitting or lying times.

Checking whenever you change position is recommended

Watch For? Any areas previously broken and healed over - scar tissue breaks easily.
What Are You Looking For? Redness, blisters, opening in skin, rashes, etc. Feel for heat in red areas with the back of your fingers.
Equipment Needed? Long-handled mirrors. If you need help, ask someone to position mirrors for you - one at the head and one over the pressure point.
Which Parts To Check?

Check the areas shown in the diagram below on the front, back, and sides of your body.

Remember: Bony areas of the body are the most likely to get sores, so be sure and look at them.

When checking you skin, don't forget your groin areas for rashes or sores from tight clothing.

Men who wear an external catheter should check the penis carefully for sores or irritations.

Relieve Skin Pressure: In addition to routinely checking your skin, a second important way to prevent pressure sores is to relieve skin pressure by changing position or being positioned so that pressure is taken off a bony area. The purpose of relieving pressure is to let the blood supply get to the skin. If pressure is not relieved, blood will continue to be pressed out of a blood vessel and will not get to the skin to keep it healthy

Pressure Relief in a Wheelchair: Weight shifts are the most essential techniques for preventing pressure on the skin and muscle of the sacrum (tailbone) and each hip. Use the method you and your therapists have found to be the most effective for you. Know your skin tolerance at all times. The frequency with which you do weight shifts vary from time to time.

Cushions: A cushion for your wheelchair is essential. Cushions provide pressure relief and weight distribution and thus aid in the prevention of pressure sores. Many types of cushions exist, but there is no "ideal" cushion. Use the cushion recommended by your physical therapist/physiatrist.

  • If air is used in the cushion, check to see that it is filled correctly. If you are going to a different altitude, there will be a change in your cushion.
  • If your cushion is made of foam, check to see that it is firm and in good condition. If it gets dry, powdery and loses its firmness, replace it immediately. Use only good quality foam. Polyurethane foam with a density of 1.2 and compression of 30 to 35 is recommended.
  • In case of body weight change, you may need to change the width of your chair, the frequency of your weight shifts, and the type of cushion you use.

Never use rubber air rings or rubber doughnuts. They are dangerous because they block the flow of blood to the skin inside the leg. Weight shifts are essential. The cushion alone will not prevent pressure sores.

In Addition:

  • make sure the foot pedals of your wheelchair are adjusted to the right height for you. If your foot pedals are too high, it will put pressure on your hips;
  • Sit up straight in your chair. Slumping or slouching leads to added pressure over the end of your tailbone.
  • Lifting your bottom from the wheelchair may be managed by lifting through your arms and taking your body weight for at least 30 seconds.  If you don't have sufficient strength to do this yourself assisted relief can be practiced by leaning forwards or to one side.


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


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