8. 7. 2021
What are pressure ulcers and why do we try to prevent them?
Simply said, pressure ulcers are wounds on the skin or subcutaneous tissue caused by prolonged pressure. In the case of people in wheelchairs, these are mainly places in the area of the seating areas and bone protrusions, but also in the area of the hindquarters and vertebrae. The onset of pressure ulcers is mainly affected by the mentioned pressure, mechanical influences (shear forces and friction), humidity, infections, age and weight of the patient, but also nutrition, concomitant diseases, drugs and other factors.
It seems like a banality, because which of us sometimes doesn't rub our skin. However, people with spinal cord injuries know that this is a really serious problem. Due to the inability to perceive pressure and pain in the limbs, bruising of the skin and subsequent pressure ulcers can occur very quickly. If the problem is not detected in time, it must often be solved by surgery - plastic surgery, removal of necrotic tissue, sometimes by amputation of the lower limb.
In the experience of wheelchair users, literally on their own skin, it has been confirmed that an inappropriate anti-decubitus seating system can cause pressure ulcers and that, conversely, the right one for a given user can prevent pressure ulcers or significantly speed up their treatment.
According to the WHO, every year in the world there are between 250 thousand and 500 thousand people with spinal cord injuries, 90% of whom are the result of an injury. A study published in March 2020 at the BMC Musculoskeleton Disorders shows that 30-40% of people with spinal problems are treated for pressure ulcers. Pressure ulcers and the complications associated with them are one of the most common causes of death in wheelchairs.
The most common areas of pressure ulcers
Bit of history
Pressure ulcers are not a disease of the 20th century, on the contrary. The lifespan of patients with spinal disease until the beginning of World War II was estimated at only two to three years of life due to circulatory disorders and skin infections.
The breakthrough did not occur until 1944 thanks to the British neurologist Ludwig Guttmann. He founded the first spinal unit in the British Stoke Mandeville Hospital. He introduced into regular practice regular reversal of patients with spinal disease, relief of bruises and elimination of infection and pressure ulcers.
In the Czech Republic, the topic of prevention and treatment of pressure ulcers has been addressed, for example, by a specialist in healthy sitting in a wheelchair - Zdeňka Faltýnková for over 40 years.
Ludwig Guttman, National Spinal Injury Centre in London, 1949
The treatment cost is enormous and early prevention is considered the most effective approach. This includes regular repositioning during the day, daily checks of the sitting areas and body symmetry in a wheelchair, strict hygiene, the use of an anti decubitus seat and proper care.
An appropriate preventive approach will prevent health complications that would not only affect the user himself but also burden his close family and the social system with intensive care and financial costs. In the end, we all can gain from careful prevention.