DECUBITUS

During your illness, your state may compel you to periods of immobility longues.Qu more or less they are related to fatigue or due to treatment following an operation, immobilization and your general fatigue may be responsible for cutaneous, bedsores. Additional source of discomfort and pain, everything must be done to avoid them.

What is a scab?

The mechanism most commonly described for the formation of bedsores is pressure on soft tissue between a bony prominence and the bed or chair where the patient rests. This pressure causes a crash of small blood vessels in the area, causing ischemia (lack of irrigation) to the origin of its necrosis (localized death)

The slough is a pressure ulcer, very susceptible to infections and takes a long time to heal.
Why a slough is formed?

Bedsores occur especially in bedridden people, or minimal movement, but are not a direct result of cancer. Bedsores are a common condition that can cause complications graves.Les regions most susceptible to pressure sores are obviously those where support is: buttocks, heels, lower back, sacrum, elbows, shoulder blades , back of the head, and this, especially as the patient is not in good conditions of bed rest or sitting.

The difficulty of early diagnosis of ulcer lies in the fact that its development began in the subcutaneous tissues, and therefore well before being visible. It then reaches the skin tissue itself, dermis and epidermis.

We must not reduce the incidence of pressure ulcers only to mechanical factors because it is not an ordinary wound, either in its formation or in his care. It is a wound that always falls within a general context is the visible face of the iceberg, the localized expression of a clinical condition that we absolutely appreciate a whole.

Symptoms: It starts with redness, which becomes gradually more marked and that darkens, becoming dark and unresponsive. And disappearance of necrotic skin gives way to an ulcer, exposing the underlying tissues. We should stress the importance of general treatment. The patient should be treated by identifying the circumstances of the occurrence of pressure ulcers to develop local care and overall quality. The first decision is the elimination of the support on the area concerned without endangering other body areas. Nutrition and hydration are also fundamental in nature.

How to treat pressure ulcers?

The description and evaluation of the initial state of the ulcer are essential to choosing a strategy of treatment and care. It will specify the number and location of each violation, stage, size and depth of the wound, the appearance of the skin bordering the lesion. Finally, a pain assessment of its permanence or linked to care. One of the first principles is the early detection of pressure ulcers. His salary is less difficult, that the lesion is beginner. When only the red is visible, it should be treated by removing the pressure, changing position every two to three hours.

Massaging the area may be useful. In case of pressure ulcers, there should be a general treatment of the patient fight against malnutrition and dehydration, while treating the wound locally. This one must above all be kept clean, but the use of antiseptics, often allergenic, is not always advisable.

Contrary to popular belief, wounds heal better in wet than in dry: dressings will therefore have a role to maintain humidity at the wound. There are many types depending on the stage of ulcer. Most are left in place several days and can be washed without wetting the wound. Once the wound thoroughly cleaned with saline, all the dead tissue is removed (excision), and the dressing is placed, the purpose of cleansing.

→ Various dressings

• Hydrocolloids and hydrogels: derived from cellulose, Hydrocellular are mostly used on exuding wounds and hydrogels on dry wounds.

• For polyurethane: transparent films now a humid climate, but permeable to water vapor, thus preventing maceration.

• Alginates: derived from brown algae, form a gel with the exudate from the wound • Dressings coal: on contaminated wounds.

• Tulle mesh often covered with vaseline, paraffin, antibiotic or antiseptic. Usually reserved for wounds whose healing is underway.

• Pulp and gels osmotic proteolytic enzymes: used for cleansing.

Budding (beginning of healing) is then stimulated by using fatty dressings changed every two days (or hydrocolloid dressings Hydrocellular), then réépidermisation is finally assured by the use of fat dressings (hydrocolloids and polyurethane film ).

Protect bedsores?

The slough is multifactorial and we know that two risk factors are essential, immobility and malnutrition. It should therefore be taken to relieve pressure in sensitive areas by the use of materials (mattresses, pillow-top mattresses, seat cushions), stimulate mobility and of course ensure good nutrition and variety. Finally, through targeted information, encouraging participation of the patient and his entourage.

The installation in bed or chair must take account of good joint position, duration of downtime and frequent changes of position, the patient's autonomy. Hygiene is of course a fundamental role and can be combined with massage, providing relief and comfort. Finally rehabilitation care mobility postoperative phase should be considered quickly. Vigilance is paramount and we must always keep in mind that prevention should begin as soon as risks are identified.

→ Evolution of care Recent years have seen the emergence of new generations of products are becoming more sophisticated, no longer the simple role of dressing but helping truly healing. These substances play a role in the microscopic phenomena of healing.

They use:

• Growth factors: Substances with a role in stimulating the growth of skin cells (platelets or patient's blood, synthetic substances).
• The skin substitutes dressings containing skin cells (cultures of skin) or biological substances (hyaluronic acid or collagen).