Bedsores
Depressed wounds, ulcers, or adolescents occur with prolonged pressing of soft tissues to the bony protuberances; Typical bridges of bedsore formations are the sacrum, hips and heels. The compression restricts the capillary circulation in the skin and the underlying tissues, which can eventually lead to massive cell death and tissue destruction. The process of disintegration of tissues begins imperceptibly and gradually progresses. It may take several days before the amount of tissue damage becomes obvious. The depth of decubitus can vary from millimeters to several centimeters up to the destruction of muscles and bones. Ulcerative defects are formed, as a rule, in elderly and weakened patients who are unable to move after surgery, as well as bedridden patients suffering from any kind of muscular or neurological disease. Bedsores can not respond well to treatment, so the main task is to prevent them. Patients at risk of bedsore formation should lie on a special mattress that provides less pressure on problem areas; all sorts of pillows help to change the position of the patient in bed. This picture shows a decubitus on the patient's lower limb, filled with necrotic (dead) masses. To combat the process of disintegration and stimulation of healing, antibiotics and, possibly, the use of special surgical larvae will be required. Ulcers of the lower extremities, although resembling bedsores, have a completely different developmental mechanism. About 80% of them arise from damage to the valvular apparatus of the venous system of the lower limb, which greatly complicates the outflow of fluid from the tissues and can ultimately lead to ulceration (trophic ulcers).
Treatment
The main method of treatment of trophic is the use of external compression of the lower extremities with the help of elastic bandages or compression linen. These measures facilitate the venous return of blood to the heart, preventing accumulation of fluid in the ankle and shin area.
Ischemic disease
In a small percentage of patients, ischemia of the lower extremity tissues results in ulceration, resulting from the occlusion (blockade) of the arteries supplying. If the blood circulation in these vessels decreases to a certain critical level, the tissues do not receive enough oxygen and nutrients and die off. In severe cases, if the restoration of blood circulation by surgery is not possible, the patient is threatened with the loss of part or an entire limb. Wounds of all types have certain common features: at the heart of their healing lie the same cellular mechanisms; any wound is at risk of infection. Surgical wounds and other types of acute wounds are usually closed by suturing - the process consists in bringing the edges of the wound closer together and connecting them with suture material. Despite the fact that extensive burn wounds and ulcers can be closed surgically with the use of skin grafts, in most cases, the healing of ulcerative defects of the lower limbs and pressure sores is carried out by "secondary tension". The wound is superimposed with a special bandage, which gradually germinates with a granulation (healing) tissue. At the end of this process, the newly formed epithelium (skin) begins to grow from the edges of the wound to its center until it closes the entire surface of the granulation tissue and restores the integrity of the skin. Extensive wounds can be closed with a skin graft, that is, by transferring a section of healthy skin to the lesion. The isolation of microorganisms from the wound is not in itself a sign of the presence of infection, since wounds of any type are rapidly seeded by bacteria from a large number of possible sources. The consequences of bacterial contamination of the wound depend on many factors, including:
• number of microorganisms;
• the ability of microbes to cause disease;
• the ability of the body's own defenses to overcome a possible infection.
Conducting wounds
Conducting an infected wound involves both systemic and local activities, including prescribing antibiotics (when indicated) and dressings using appropriate material (which may have certain antibacterial properties). The advisability of topical application of antibiotics is doubtful, because it can provoke the development of hypersensitivity reactions or lead to the emergence of resistant (resistant) strains of bacteria. The dressing material is mostly made in such a way as to maintain moist conditions in the wound; this prevents further damage and promotes the growth of new tissue. In the absence of adequate measures to fight infection, the development of cellulite (bacterial infection of the subcutaneous tissue), which creates the danger of penetration of microbes into the blood (bacteremia and septicemia).