Pressure Ulcers

Pressure ulcers are injuries to the skin. They most often occur to bony areas where there is a lot of pressure. More specifically, they develop as a result of patients sitting or lying in one position for too long. The lack of position change causes a build up of pressure to certain areas of the body. Pressure sores can also develop as a result of a patient sliding down in a chair, bed or if a patient is dragged across a bed sheet. These are referred to as shearing and friction injuries. Patients who are at the highest risk for developing these types of injuries are those who cannot move on their own or change positions on their own, who are incontinent, lack proper nutrition or who have medical co-morbidities. Causes of pressure ulcers included the following:

• Poor circulation
• Venous insufficiency
• Diabetes
• Sedentary lifestyle (pressure build up)
• History of smoking
• Hypertension
• Heart Disease
• Renal failure
• Lymphedema
• Medication Reaction
• Tumors
• Infection

Again these ulcers are most likely to occur over bony parts of the body where there is greater pressure build up with lack of position change. This is largely due to the lack of cushion to those areas. Most often these injuries are noted to the lower part of the body including the tailbone along the spinal column, buttocks, hips and heels. Other places where these types of ulcers can develop include the back of the head, ears, shoulders, elbows, ankles, and between the knees.

Pressure ulcers can be prevented if the following interventions remain consistently in place;

• Frequent position changes
• Patient’s skin is kept clean
• Patient’s skin is well moisturized (dry skin can easily break down)
• Healthy diet
• Proper position (whether in bed or in wheelchair)

There are three types of lower extremity ulcers. They are Venous Stasis Ulcers, Arterial Ulcers, and Diabetic Ulcers.

Venous Stasis Ulcers
These ulcers are located below the knee but above the ankle. Most often they are found in the inner part of the leg. Venous stasis ulcers are commonly in patients with a history of leg swelling, varicose veins or those patients who have history of blood clots (either superficial or deep vein). They affect between 500,000-600,000 people in the United States each year and account for 80-90% of all leg ulcers.

Venous stasis ulcers are usually red in appearance and may have yellow tissue covering the wound. If they become infected, a yellow or green discharge is noted. The borders around the wound are irregularly shaped and the surrounding skin tends to look discolored and swollen.

Arterial Ulcers
These types of ulcers are usually located on the feet. In particular they will be found on the heels, tips of the toes and between the toes. Arterial ulcers typically do not bleed and can have a yellow, brown, grey or black color to them. The border area around the ulcers usually appears punched out. Swelling or redness may not always be noticed with these ulcers. However, when redness is seen, the entire foot can be affected. Arterial ulcers are known for being very painful.

Diabetic Ulcers
These types of ulcers are most often located where there are increased pressure points on the bottom of the foot. However, if the ulcer develops in relation to a traumatic injury, it can occur anywhere on the foot. The appearance of the ulcer depends on the patient’s condition and can range from pink/red to brown/black. The surrounding skin can appear calloused.

Skin wounds can have devastating effects for a patient, especially those who are already medically compromised. The medical record review for these cases requires an in depth look at care prior to appearance of the wound, not only including hygiene and position changes but also medication regimen and nutritional status. For assistance with your cases that involve a wound such as a pressure ulcers contact our office today at 630-551-0978 or info@medicaljurisprudence.com to learn more about our medical legal consulting services.