Pressure induced ulcers are most common among patients confined to a bed or chair. Ulcers usually result from unrelenting pressure on the skin. Damaged skin or bed bruises may develop into decubitus ulcers. 

Another type of decubitus ulcer is known as a Kennedy Ulcer. Kennedy ulcers, also known as Kennedy Terminal Ulcers (KTU), are dark sores that develop rapidly during the final stages of life. Kennedy ulcers grow as the skin breaks down-  part of the dying process. Not everyone experiences these ulcers in their final days, but they're not uncommon.

Factors causing Decubitus Ulcers: If a bed sore becomes infected it may become septic. Sepsis often leads to death. Pressure is the primary factor causing bedsores, but there are other factors important for ulcer formation. Some "rules of thumb" that will help prevent pressure sores in people confined to a bed or chair:

• Avoid rubbing skin vigorously. Vigorous rubbing may be painful and may cause inflammation or destruction of tissue, especially in frail elderly individuals.

• Do not massage the skin to prevent pressure ulcers. Massage is contraindicated if the skin is fragile or inflammation is present; blood vessels may be damaged.

• Do not turn the individual onto a body surface that is still red from previous weight bearing. Redness indicates that the body requires additional time to recover from the previous pressure loading.

• External Factors:  Slight trauma caused by garments rubbing against the skin or folds in the bed linen may cause tingling of the skin. Sweat and urine will also reduce the integrity of the skin.

• Internal Factors:  Internal factors may lead to a weakening of the response to infection. This may reduce the blood supply to tissues and consequently the development of an ulcer.

* Vulnerable Regions:   Body paralysis results in probable ulcer development. Early development of pressure sores is first seen in the sacrum (tail bone area), trochanter, ischium, head of fibula, heels and toes. For patients in hospital beds, the tail bone area, ribs, the front and iliac peaks are likely areas of pressure sore devel;opment.

Phases of Ulcer Development:

Ulcers develop through 4 stages:

1. In the beginning stage, the sore is developing. The skin is blushed. Underneath the skins surface there is swelling, but the blood vessels are still intact. Loss of vasomotor control results in the inability to regulate blood vessel constriction.

2. In the second stage, the sore develops with the skin changing color to a dusky red. Reduced blood flow occurs in the area accompanied by a loss of sensation.

3. The third stage is recognized by little breaks in the skin. It is from here that ulceration spreads.

4. In the fourth stage, tissue rot and ensuing ulceration will result. Infection is a major problem at this time.

Preventive Measures:

• Avoiding unnecessary tension on any part of the skin.
• Eliminate pressure on the affected areas.
• A balanced diet helps to maintain skin integrity.

Pressure Sore Prevention Products:

• provide real improved comfort with 1900 grams/square meter of Merino sheep's fleece.

• give outstanding pressure reduction.

• can be machine washed in Woolskin and tumble dried.  offer an outstanding option to the Australian Medical Sheepskin (AS4480.1)

• provide even better improved comfort with about 3000 grams/square meter of Merino Lambs Wool
• give excellent pressure reduction, moisture absorption and shear reduction- the 3 major causes of pressure sores.
• can be machine washed in Woolskin and air died.

 Insights:  Approximately 1 million individuals in the USA experience the ill effects of decubitus ulcers or pressure sores..ranging from gentle aggravation to profound wounds. Analysis shows that pressure ulcers beset: 10% clinical patients, 25% nursing home occupants and 60% of quadriplegics..

What is a Bedsore: Pressure Sore: Pressure Ulcer: Pressure Injury?.... AND... how can I Prevent them?

It is good that we toss and turn in bed or move often in a chair. Such movement redistributes the pressure on your body from the mattress or cushion. If illness or injury prevents movement, pressure builds up on pressure points and local blood circulation is reduced. Reduced local blood flow can cause skin and underlying tissues to die, creating a bedsore / pressure sore. A few simple steps, can help prevent these painful, dangerous, and costly sores; reports the November 2006 issue of the "Harvard Health Letter." In 2006, Medicare in the US, logged nearly 323 000 cases of pressure sores as secondary diagnoses. The average cost of treating pressure sores was $40,381.00 in 2006 dollars. Obviously, it is even more now.

Medical Sheepskin and Merino Lambswool will prevent and treat pressure sores.

Pressure sores are painful, debilitating and unnecessary. Use this guide to learn about bed sores and their prevention. Bed sores can develop very quickly and may progress into a Stage 4 pressure ulcer; like the one shown below. Preventing this from happening should be of primary concern for all caregivers. These same products are also helpful for improving the comfort level of people who have just had a hip or knee replacement.

Bed sores are often first seen in the tailbone or ankle areas. 

Preventing bedsores is the logical and most humane method you have of caring for those confined to a bed or wheelchair.

                                                        American Family Physician, October 1996: v54, n5, p1519

" It is estimated that 95 percent of all pressure ulcers are preventable. Prevention rather than mere treatment of established ulcers remains a top priority in the effort to reduce the incidence of this common, complex and difficult problem"

Bed Sore Prevention Guidelines:

1. Take care of the skin:
Inspect the skin daily. Pay special attention to red areas and pressure points. Minimize moisture contact with the skin. Australian Medical sheepskins reduce pressure and will wick moisture away from the skin, keeping it dry.
Pressure sores often are first seen in the tail bone area followed by the heels.
2. Protect the skin from injury:
Avoid massaging skin over bony areas. Change body position at least every 2 hours- more frequently in a chair. Reduce friction ( rubbing) by lifting rather than dragging. Do not use donut shape cushions. These can increase the risk of getting pressure ulcers by reducing blood flow in the areas of contact with the cushion.

If the patient is confined to a bed, reduce pressure points with Australian Medical Sheepskins. The head of the bed should be raised as little as possible. When the head of the bed is raised above 30 degrees, the body may slide over the bed surface, damaging skin and small blood vessels. Pillows or wedges should be used to keep knees and ankles from touching each other. Patients should avoid lying directly on the hip bone when lying on their side. Pillows and Medical Sheepskin will help. If the patient is completely immobile, pillows should be put under their legs from mid-calf to ankle to keep heels off the bed. Never place pillows under the knees- this reduces blood circulation. 

3. Eat well:
Eat a balance diet. Proteins and calories are very important for healthy skin. Healthy skin is less liable to be damaged.

4. Improve the patients ability to move:
A rehabilitation program can help some people gain movement and independence. The patient can help to prevent most pressure sores.

Bed Sores, decubitus ulcers and pressure sores develop through 4 stages. Notify your medical practitioner and nursing staff if you notice

 Stage1. You will notice redness of the intact skin. The skin is unbroken, but inflamed and may be painful and warm to the touch. You might also notice the skin's texture may be spongy or firm.

Stage 2. Here you will see the first sign of skin breakdown and partial skin loss. It will look like an abrasion, blister or shallow crater. The outer layer of the skin is broken, red and painful. Surrounding tissue may be pale, red or swollen.

Stages 3 & 4 result in ulcer production. The skin has broken down and there is extensive destruction or damage to the underlying muscle, bone or supporting structures. Ulcers are extremely difficult to heal and may take many months for complete repair. Preventing the development of an ulcer should be considered seriously.

 Bed sores, decubitus ulcers and pressure sores are unnecessary and can be prevented. Prevention is possible when you provide an environment for the patient that does not foster the formation of bedsores. This environment can be produced by Australian HiTemp UR Medical Sheepskins. These sheepskins are approved FDA Medical Devices.

Pressure Ulcer Stages Revised by NPUAP:

February 2007 - The National Pressure Ulcer Advisory Panel (NPUAP) redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original 4 above stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers. 

Pressure Ulcer Definition- A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. 

Pressure Ulcer Stages:

Suspected Deep Tissue Injury:
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by painful, firm, mushy, boggy, warmer or cooler areas as compared to adjacent tissue.

Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Stage I:
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage 1 may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a heralding sign of risk)

Stage 2:
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
*Bruising indicates suspected deep tissue injury

Stage 3:
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

The depth of a stage 3 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage 3 ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage 3 pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage 4:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

The depth of a stage 4 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage 4 ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.

Unstageable:
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

If a bed sore has developed already, the best thing that you can do is to try and reduce the factors causing the bed sore. Pressure often a major cause of bedsores. Pressure against small blood vessels in the skin will cause them to collapse with a resulting decrease in blood flow. Low oxygen and nutrient levels results in skin death. The death of the skin is the beginning of what is recognised as a bed sore. To prevent this from happening, you must reduce the pressure on the skin. This can be achieved by lying/sitting on a Australian Medical Sheepskin. Australian Medical Sheepskins also wick moisture away from the skin; keeping it dry and firm. Moist skin is more likely to tear when a person moves. Australian Medical Sheepskins also reduce friction. If a person lies directly on a Australian Medical Sheepskin, skin abrasion and tears are less likely to happen.

Premium grade Australian Medical Sheepskins AS4480-1 add comfort and an improved feeling of well-being to those confined to a bed or wheelchair. The 2004 clinical trial at the Royal Melbourne Hospital found that people placed on these Australian Medical Sheepskins had 58% fewer bed sores than those placed on regular bed linen. 

Also consider these Pressure Sore Prevention Products:.

 Order from The Pressure Sore Prevention Store, with its secure payment gateway. Or, if you are not sure about the best product for your situation, call us at: 1- 800- 463- 1985

Pressure Smart XD1900 is a new range of wool products, specially developed for the Prevention of Pressure Sores and Decubitus Ulcers. Pressure Smart XD1900 is made from Merino Superwash Wool and has a pile density of 1900 grams/meter². Because it is a manufactured product, all products have a uniform 30mm pile.unlike sheepskins which vary significantly.

Pressure Smart XD products are: machine washable and can be dried in the dryer..making them eminently suitable for institutional use. These products are recommended for incontinent clients; because of their ease of care and pressure sore prevention properties.

Consider these new Pressure Smart XD 1900 products:

• M102XD- Overlay- 26" x 40"- protection from shoulders to below the buttocks.
• M103XD- Pressure Care Assist for heel protection
• M105XD- Cushion-It for wheelchairs
• SC104XD - Superior Pressure Smart XD Overlay- 30" x 60"- for total body protection.