A physician generally determines how frequently a bed sore should be measured and re-assesed on a formal basis.  Nonetheless, staff should note any rapid deterioration or unusual changes and bring the changes to the attention of a treating physician if warranted.

The healing time for a bed sore depends on the size and severity of the wound(s).  For example, a stage 1 bed sore may heal within a few days while a stage 4 bed sore may take several months or more. Patients suffering from severe bed sores may require years of medical treatment.  Unfortunately, some bed sores may never heal– especially when the person has other illnesses or is elderly.  There are no specific guidelines that can be used to predict whether an ulcer will be “non-healing.”

Despite the apparent benefits of using Clinitron beds, some facilities are slow to acquire this technology because these beds cost more than traditional models.

Clinitron is a trademark of Hill-Rom.  Below is a picture of a Clinitron bed from the companies website.

Amputation is the surgical removal of a limb or body part (arms, legs, feet, fingers, toes), usually to remove diseased tissue or relieve pain.  The amputation procedure is performed by an orthopedic surgeon in a hospital operating room under regional or general anesthesia.

The procedure varies depending on which limb is removed; however, all surgical amputations involve removing diseased tissue and constructing a stump, which will fit a prosthesis.  The procedure for an above-the-knee amputation includes: first cutting the skin and muscle layers, then clamping the major blood vessels and cutting them, then cutting the bone with a bone saw, and finally, the muscles are stitched together over the bone and the skin is closed over the wound.

The decision of how much of the limb to remove depends on how much tissue needs to be removed for proper healing, while saving as much of the healthy skin, blood vessels, and nerve tissue as possible for rehabilitative purposes.  One test that the surgeon performs to determine the health of the limb is the amount of blood flow to the affected region (measurement of blood pressure in the limb).

As with other major surgeries, amputation carries with it the same risks including complications with anesthesia, blood loss, and blood clots; however, infection is the main complication following surgery.  Amputation is a painful procedure, requiring treatment with pain medication and antibiotics post-surgery, and a hospital stay ranging from five to fourteen days, absent further complications.  Following surgery, the newly formed stump must be moved often to encourage circulation, with physical therapy commencing as soon as possible.  The rehabilitative process is a long process, especially for above the knee amputees.  The physical rehabilitation is often accompanied by grief counseling to help the patient cope with the sense of loss that comes with losing a limb.  Patients also often have phantom limb pain, which is very difficult to treat.  Amputation is a last resort for both physicians and patients, but in some cases, as with severe pressure sores (which are likely preventable), it becomes necessary.

Sources:
MayoClinic.com – Pressure Sores
Merck – Pressure Sores
Encyclopedia of Surgery – Amputation
Vascular Web – Amputation

Related:

A Graphic Example Of Nursing Home Negligence: Amputation Of A Leg Due To Untreated Bed Sores

DuoDerm dressings are impermeable to water vapor, oxygen and bacteria.  One of the reasons DuoDerm dressings are so popular is because they will not stick to the wound bed itself and can be removed without tearing the granulation tissue underneath. They are best applied to wounds that produce light to medium exudate or transudate (extravascular fluid with low protein content, a low specific gravity and low nucleated cell counts).  Depending on physician orders, DuoDerm dressings can be used on stage 1, 2, 3 and 4 bed sores.

The length of time a DuoDerm patch may be left on a wound is determined by the amount of moisture in the wound.  Under normal conditions, DuoDerm can be left on the wound for 3-4 days.  One of the advantages to using DuoDerm is that, unlike other dressings, it can be placed on wet wounds and wet surrounding skin and will remain in place due to the product’s ‘wet tact’.

Because DuoDerm essentially creates a moisture barrier, they should not be used on people with infected bed sores.  Under normal circumstances, wounds covered with DuoDerm are likely to develop a strong odor after several days.  The odor is consider to be a normal part of of the product.

The process uses a pressurized chamber filled with 100% oxygen where a person will sit or lay for a specified period.  The pressurized oxygen helps the body in its own natural healing process.  Hyperbaric oxygen therapy has been shown to help individuals with not only serious bed sores, but also complications such as gangrene, infection and osteomyelitis.

Despite the fact that flap reconstruction surgery provides an opportunity to help heal open wounds, there is a high risk of complications related to infection and the bodies rejection of the ‘flap’ skin and muscle.  In order to promote maximum healing, air mattresses and regular ‘turning’ should provided by caregivers during the post-operative period.

It should also be noted that the reconstructive flap does not generally allow sensation.

A colostomy is a major surgical procedure that involves cutting the colon into a shorter piece and bringing it through the wall of the abdomen.  A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected.  The end of the colon that leads to the rectum is closed off and becomes dormant.  Many colostomy procedures can be reversed, if and when they are no longer needed.

While the thought of a colostomy may be disheartening, for many people suffering from severe bed sores it is likely an essential part of the overall healing process.  Without a colostomy, many bed sore patients suffer from recurring infection and even sepsis.

By some accounts, the body requires almost twice as much energy to heal a bed sores compared to a similarly situated ‘healthy person’.  Most experts estimate the body requires 35-40 calories/kg of body weight to properly heal.  Using these suggestions, patients with advanced bed sore would require the following daily caloric intake:

• 100 lbs.: 1,587 – 1814 daily caloric intake
• 150 lbs.: 2,381 – 2,721 daily caloric intake
• 200 lbs.: 3,175 – 3,628 daily caloric intake

Source:

Nursing Homes Abuse Blog:

Bed sores can be a very serious condition depending on how much skin and tissue is damaged.  Deep pressure sores can go all the way down to the muscle or even the bone.  Stage III bed sores result when the tissue below the skin is damaged, causing a deep wound.  Stage IV bed sores are the most serious pressure sores and involves destruction of large areas of skin accompanied by damage to the underlying muscle, bone, tendons, and joints.  If not treated properly, infection can set in and even require amputations.  Signs of infection include pus, bad smell, redness, swelling, tenderness, fever, and chills.

Surgical debridement (removal of damaged tissue) is one approach to treating serious bed sores.  This process can be very painful because it involves using a scalpel or other instrument to remove all the dead tissue.  Some bed sores reach a point where surgical repair is necessary.  The treatment usually involves harvesting tissue from another area of the body and using it to pad the wound.  In some situations, amputation is necessary.

When bed sores are not treated properly, tissue damage can spread and infection, including gangrene, can set in.  In severe cases (where surgical debridement, antibiotics, and oxygen treatment are unsuccessful), amputation of the limb might be required to prevent the infection from spreading further.  This is especially true in elderly people, especially those who are malnourished, because of poor blood flow.

Amputation is the surgical removal of a limb or body part (arms, legs, feet, fingers, toes), usually to remove diseased tissue or relieve pain.  The amputation procedure is performed by an orthopedic surgeon in a hospital operating room under regional or general anesthesia.  The procedure varies depending on which limb is removed; however, all surgical amputations involve removing diseased tissue and constructing a stump, which will fit a prosthesis.  The procedure for an above-the-knee amputation includes: first cutting the skin and muscle layers, then clamping the major blood vessels and cutting them, then cutting the bone with a bone saw, and finally, the muscles are stitched together over the bone and the skin is closed over the wound.

The decision of how much of the limb to remove depends on how much tissue needs to be removed for proper healing, while saving as much of the healthy skin, blood vessels, and nerve tissue as possible for rehabilitative purposes.  One test that the surgeon performs to determine the health of the limb is the amount of blood flow to the affected region (measurement of blood pressure in the limb).

As with other major surgeries, amputation carries with it the same risks including complications with anesthesia, blood loss, and blood clots; however, infection is the main complication following surgery.  Amputation is a painful procedure, requiring treatment with pain medication and antibiotics post-surgery, and a hospital stay ranging from five to fourteen days, absent further complications.  Following surgery, the newly formed stump must be moved often to encourage circulation, with physical therapy commencing as soon as possible.  The rehabilitative process is a long process, especially for above the knee amputees.  The physical rehabilitation is often accompanied by grief counseling to help the patient cope with the sense of loss that comes with losing a limb.  Patients also often have phantom limb pain, which is very difficult to treat.  Amputation is a last resort for both physicians and patients, but in some cases, as with severe bed sores (which are almost universally preventable), it becomes necessary.

Sources:
MayoClinic.com – Pressure Sores
Merck – Pressure Sores
Encyclopedia of Surgery – Amputation
Vascular Web – Amputation

Related:

A Graphic Example Of Nursing Home Negligence: Amputation Of A Leg Due To Untreated Bed Sores

In 2000, the FDA approved wound vacs for use in bed sore patients.  Studies have demonstrated that use of wound vacs helps the wounds heal faster and reduce the incidence of infection.  In situations where a wound vac is used, patients tended to have enhanced granulation of tissue formation, decreased bacteria and increases in cutaneous perfusion and oxygen tension compared with residents where the procedure was not used.