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A pressure ulcer is a sore caused by too much pressure on the skin. This reduces blood flow, damaging skin and underlying tissue. The result is a wound that can be quite serious. Having an SCI makes you more likely to develop a pressure ulcer. But there are steps you can take to help prevent these sores or catch them early when they’re most treatable. Your healthcare team has likely discussed pressure ulcer prevention with you. Now it’s up to you to put what you learned into practice.
Having an SCI affects your ability to feel and to move. It also causes skin changes that may make your skin more fragile. The conditions that lead to ulcer development include:
Pressure: Pressure forms anywhere your body presses into a surface. Commonly, this is a mattress or your wheelchair seat, back, or footrest.
Rubbing: This is also called “shearing” and “friction.” It occurs when your skin slides against or across a surface. Examples are clothing or bedding, part of the bed or wheelchair, or even the underlying bone.
Pressure ulcers are most likely to form over bony prominences. These are places where bones are felt right under the surface of the skin. These include your:
“Sit bones” (buttocks)
Pressure on your skin will change depending on whether you are sitting up or lying down, and whether you lie on your back or side.
Your care providers will help outline the ulcer prevention plan that’s best for you. The main steps to help keep skin healthy and prevent ulcers are listed below. Depending on the extent of your injury, you may need help performing some or all of these steps. Be sure to:
Change positions regularly. Your care provider will give you guidelines for how often to shift your weight when you’re in bed or in your wheelchair. In general, change your position (or have someone help you move) every 15 minutes for 15 seconds. To prevent rubbing, lift your body, don’t drag it.
Check your skin twice a day. Look and feel your skin carefully. Check especially over your bony prominences. Use a mirror to see behind you or where you can’t reach. If you can’t use a mirror, ask someone else to check the area. Inspect your skin once in the morning and once in the evening. Look for any of the warning signs listed in the box below.
Keep skin clean and dry. Clean and dry yourself after sweating or a bowel or bladder accident. Avoid harsh soaps or alcohol that dry out the skin.
Use the right equipment and check it regularly. Your care team can help you find the devices and equipment that are best for you. Be sure to check that things like your wheelchair back and cushion have not worn out.
Eat well and stay active. These will help keep your skin and body healthy, so pressure ulcers are less likely to form.
Check your skin daily for the following. If you notice any changes or problems, call your healthcare provider right away.
Skin redness that doesn’t go away in 15 minutes
Other skin color changes
A spot that is soft, warm, or cool
Scrapes, cuts, or blisters
A spot that hurts or itches (if it has sensation)
Note that ulcers can begin deep below the surface of the skin. So an open wound is not necessary for a pressure ulcer to be present.
If you notice an area of redness, take all pressure off that area. (This may require you to go on bedrest.) See if the skin color returns to normal within 24 hours. If it does not, call your healthcare provider right away. And call right away (don’t wait) if you see any open sore or other signs of skin damage.
Treatment will vary depending on your health, the size and stage of the ulcer, and other factors. The most important thing is to keep pressure off the area. Treatment options that may also be used include:
Special medical wound cleansers and dressings (don’t use anything that isn’t prescribed)
Methods to remove dead tissue from the wound so it can heal
Antibiotics to clear up an infection
Medical procedures or surgery to close the wound
Pressure ulcers usually begin to heal within 2 to 4 weeks. While the ulcer is healing, monitor it for signs of complications. Inspect the ulcer during each dressing change. If you can’t do this, have someone who helps with your care inspect it for you. Problems to watch for include:
Further changes in skin color or temperature
Fluids soaking through the dressing
Pain (if the area has sensation)
If you notice any of these or any other problems, tell your healthcare provider right away.
Depending on the level of your injury, you may be told that you are at risk for autonomic dysreflexia (AD). If AD is a risk for you, know that a pressure ulcer can trigger AD. If you have an AD episode, check your skin carefully for signs of a pressure ulcer. And if you develop a pressure ulcer, be alert for signs of an AD episode.
Having an SCI means having a lifelong risk for developing pressure ulcers. So take steps every day to prevent the ulcers and check your skin for warning signs. Get help and support from your family, caregivers, and healthcare team. And if you develop signs of a pressure ulcer, tell your healthcare provider right away. You may not be able to prevent every pressure ulcer. But you can prevent them from keeping you from living your life to the fullest.
For more information about SCI, go to:
The National Spinal Cord Injury Association, www.spinalcord.org
Christopher and Dana Reeve Foundation, www.christopherreeve.org
Paralyzed Veterans of America, www.pva.org