By Jeffrey M. Levine MD, and Michael Cioroiu, MD
Pressure ulcers are breaks in the skin over boney areas, such as the heel, elbows and tailbone. They occur in people who are at special risk for skin breakdown, including:
• Patients with spinal cord injuries
• People who are bed-bound with advanced dementia or chronic debilitating neurologic disease like multiple sclerosis
• Individuals with acute illness requiring stays in the intensive care unit
Risk Factors
Factors that increase the risk of pressure sores include:
• Poor nutrition
• Immobility, such as when illness requires bed rest
• Excess moisture
• Lack of sensation
• Irritations like friction and shearing forces (when two surfaces move in opposite directions, such as when sliding down in bed and the tailbone moves down but the skin over the bone stays in place)
Symptoms and Treatment
It is always much easier to prevent pressure ulcers than heal them. Once the skin breaks down, the symptoms can include burning and discomfort, and the treatment can necessitate surgical intervention depending on severity of the wound.
Strategies for Prevention
The strategy for preventing pressure ulcers varies from patient to patient, but generally includes certain basics:
1. Pressure Relief — Involves turning and positioning the patient in conjunction with devices that relieve pressure. These can include special cushions, mattresses, beds and protective devices for the feet.
2. Mobilization — Entails physical therapy and supplying the patient with such devices as overhead trapeze and ambulation aids.
3. Nutrition — Includes supplying the patient with the proper amount of protein, calories or vitamins. The process of assessing and maintaining nutrition may involve specialists, such as speech and swallowing experts, nutritionists and occupational therapists to assist the patient with adaptive devices for eating.
The Advanced Wound Healing Center
At Mount Sinai Beth Israel, we try our best to prevent pressure ulcers in all patients. When patients are admitted with these wounds, our Advanced Wound Healing Center offers a full array of nursing and medical services to care for them. For example, we have a number of specialist physicians who consult on and care for pressure ulcers using the latest techniques. And, the hospital employs nurses who specialize in pressure ulcer prevention and treatment. Once patients are discharged, the Wound Healing Center provides high-quality outpatient care.
Michael Cioroiu, MD, is Co-Director of the Advanced Wound Healing Center, and Jeffrey M. Levine MD, is a wound care physician who also has advanced training and certification in geriatric medicine.
For an appointment with the Advanced Wound Healing Center, please call 212-420-2300.