What are they?
Pressure sores or bed sores are sores that form over bony parts of the body when a person lies or sits on that particular part of the body for too longwithout moving.
Where the skin is pressed against the bed or chair, the pressure causes a decrease in the blood flow. If too much time passes without moving or rolling over, the skin and flesh in that area can be injured or die. First a red or dark patch appears, and if pressure continues the skin breaks down creating an open sore

How long is too long?

• More than 2 hours when you are lying down with turning
• More than 10 minutes when you are sitting, without doing a push-up

Why are persons with SCI prone to develop Pressure Sores?
When a normal, healthy person lies or sits in one position for a long time he begins to feel uncomfortable, which makes him/her move or roll over to let another part of his body bear his weight. A person with a spinal injury

• fails to respond to warnings of pain or discomfort due to loss of sensation and
• secondly is unable to move or roll over to relieve pressure,

These two points that make them at a very high risk of developing pressure sores.

How common are Pressure Sores?
Pressure sores are very common in persons who are bed ridden and those who have lost sensation in parts of their body such as persons with spinal cord injuries or aged persons.

How dangerous are they?
Pressure sores if allowed to develop and not carefully managed can become large and deep. They can easily become infected because they contain dead skin & flesh. If a sore reaches the bone (which it often does), it can become infected. Bone infections are very hard to cure & may last for years. Infections in deep pressure sores often get into the blood and affect the whole body causing fever and general illness. THIS CAN EVEN LEAD TO DEATH.In fact, pressure sores are one of the main causes of death in persons with spinal injury.

Where are pressure sores most likely to form?
Parts of the body where skin and subcutaneous tissues that overlie bony prominence are likely sites for pressure sore formation. The parts where they form most often are shown in the picture. The points coloured red are the points of highest risk.

What causes Pressure Sores?
The most important factor is unrelieved Pressure.
The other critical factors are:

• decreased mobility
• decreased sensations
• friction/ shearing during transfers or turning
• moisture, e.g., sweat, urine soaked clothes
• poor nutrition can cause weight loss and thus, there is loss of padding over the bony prominence.

Can Pressure Sores be prevented?
YES. Pressure sores can be prevented completely provided you turn in bed every 2 hours day and night and change position every 10 minutes when sitting.

A PRESSURE SORE TAKES ONLY HOURS TO DEVELOP BUT IT TAKES MONTHS OR AT TIMES YEARS TO HEAL. AS FAR AS POSSIBLE, YOU SHOULD TAKE RESPONSIBILITY FOR YOUR SKIN CARE YOURSELF.

a push up every 10-15 minutes when sitting and turn every 2 hours while in bed

How to protect your skin & prevent pressure sores?

• Avoid staying in the same position for very long. When lying down, turn from side to side and front to back every 2 hours. When sitting lift body up and change position every 10-15 minutes.
• Do not rub or scrape skin across bed or wheelchair when transferring or changing position.
• Use soft, clean, dry bed-sheets. Keep all clothing & bed linen free of wrinkles.
• Keep dry! Change wet clothing and/ or bed linen promptly. a person who stays wet gets pressure sores especially if it is from URINE.
• Bathe daily and dry thoroughly by patting, not rubbing.
• Examine the whole body carefully everyday, checking especially those areas where sores are most likely to occur.
  Look for the danger signs:
  • Pinkness / Redness
  • Paleness
  • Darkness
  • Unnatural wrinkles
  • Warmth
  • If any of the danger signs are present, take care to prevent pressure over this area until skin returns to normal.
• Good FOOD is important for preventing pressure sores. Be sure that you eat well, but do not become fat. Eat plenty of fruits, vegetables, pulses, beans, eggs, meat, fish, and milk products. Ghee & Oil are to be avoided.

Mattress/ Padding/ Cushions

To prevent pressure sores it is essential that you lie & sit on a soft surface, that reduces pressure on bony areas.

It is best to lie on a flat surface with a thick spongy mattress. A thick foam rubber mattress often works well. However some foam are so spongy that it sinks completely down under weight. Then the bony areas are no longer protected from pressure Therefore, the right mattress should be firm, thick and smooth.

Careful placement of pillows, cushions or soft folded blankets can also help prevent pressure sores. Correct positioning not only prevents pressure sore but also prevent contractures. In a wheelchair also always use a firm cushion, sitting directly on a canvas or metal seat can cause sores.

Care of Pressure Sores

Watch for the first sign of a pressure sore by examining the whole body every day. You can do this yourself by using a long handled mirror

If you can notice any of the danger signs, e.g., redness, paleness, darkness, warmth or unnatural wrinkles over any susceptible points, then avoid pressure on that area until the warning signs disappear. This means not lying or sitting on that particular part.

Do not rub or massage the areas where pressure sores might be forming. This could tear weakened flesh & make the sore underneath worse.

If the skin has already broken down

• Keep pressure off the affected area completely.
• Keep the area clean, you can wash it with boiled water (do not use strong antiseptics)
• Eat well. If lot of liquid comes out of the sore, a lot of protein is lost with it. This must be replaced to promote healing. Eat food rich in proteins, i.e., milk, curd, pulses, eggs, meat, fish, beans, etc. Also take iron pills, if there are signs of anemia.
• If a sore is deep and has dead flesh, consult your doctor and follow his instructions.

Some do’s & don’ts

Do’s

• Turning in bed every 2 hours, day & night, Shift weight every 10 minutes when sitting,
• Keep your body clean & dry-bathe everyday, Keep bed linen dry & wrinkle free,
• Eat good food.

Don’ts

• No talcum powder,
• no local application of spirit on skin,
• no rubber rings,
• no wrinkled sheets