Pressure ulcers are common wounds in patients who are immobile and must lie in one position for extended periods, wheelchair users, elderly individuals with frailty, those in a coma, or patients on mechanical ventilation. These wounds are slow to heal and require long-term medical care, not only causing pain to the patient but also posing a significant burden on their family and the healthcare system.
1. What are pressure ulcers? Causes of pressure ulcers
According to statistics in high-risk groups, just 2 hours of continuous lying or sitting can lead to pressure ulcers, and it takes an average of 3 months to 2 years to heal a stage 4 pressure ulcer—with a substantial financial cost. So what exactly are pressure ulcers? How do they form?1.1. What are pressure ulcers?
Pressure ulcers (also known as pressure sores, bedsores, or decubitus ulcers) are injuries to the skin and underlying soft tissue caused by prolonged pressure on the skin, leading to localized ischemia. They typically form when tissues are compressed for too long between bony prominences and hard surfaces such as beds, chairs, or even from medical tubing and devices…
In Vietnam, there is currently no comprehensive data on the cost of treating pressure ulcers. However, in the United Kingdom, the treatment cost for an uncomplicated stage 4 pressure ulcer is nearly 280 million VND (equivalent to £9,670). This was reported in a study conducted by Bennett and colleagues in 2000.
In the United States, the annual medical cost for around 1 million people affected by pressure ulcers reaches up to 1.6 billion USD… This demonstrates that pressure ulcers are a significant healthcare burden, and the best approach is to focus on preventing pressure ulcers in at-risk individuals as early as possible, rather than waiting until the ulcers worsen.
1.2. Causes of pressure ulcers
When a patient is immobile for extended periods, there is a high risk of pressure ulcers due to ischemic necrosis of the skin and subcutaneous tissue. The causes of pressure ulcers may result from a combination of multiple factors, including internal factors (related to the patient’s condition) and/or external factors (not related to the patient’s health status). Specifically:-
External factors (mechanical forces)
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Internal factors
2. Staging of Pressure Ulcers
Depending on the wound’s appearance, pressure ulcers are classified into four stages. However, some cases may not follow the standard progression or may present with additional signs. Below are the four stages of pressure ulcers:
Stage 1: Reddened skin (damage to the epidermis & dermis)
This is the stage when the pressure-affected skin begins turning red and may appear swollen. On touch, it may feel firm, warm or cooler than surrounding skin, and patients may feel pain or itching. In individuals with darker skin tones, the affected area may appear purple or bluish. Although the skin remains intact, these symptoms indicate damage to the epidermis and dermis. Special care is needed to prevent progression to ulceration. Unless advised by a healthcare professional, you should not massage these reddened areas.Stage 2: Superficial ulcer on the skin & epidermis (involving subcutaneous tissue)
At stage 2, the damage extends into the subcutaneous layer due to blistering, which disrupts and damages the epidermis. Common signs include partial loss of the dermis, presenting as a shallow open ulcer without scabs or necrosis. The base of the wound is pink-red, shallow, and dry. Visibly, the affected skin may appear blistered (intact or ruptured), resembling a superficial burn or a cut. The wound is painful, and the surrounding skin may be discolored.Stage 3: Tissue necrosis (damage to the dermis and subcutaneous layer)
In this stage, the ulcer extends into the fat and subcutaneous tissue layers, with visible necrosis, but without affecting muscle tissue. The wound appears deeper, resembling a “volcano crater.” Necrotic tissue, usually black in color, may surround the wound edges and border healthy tissue, indicating significant tissue breakdown underneath. However, visual inspection of a stage 3 ulcer alone may not reveal the full depth or internal extent of tissue damage.Stage 4: Deep tissue damage (extending into muscles and tendons)
Stage 4 is the most severe and advanced stage of pressure ulcers. The wound becomes large and may exhibit infection, tunnels, or undermining. All skin and subcutaneous tissue are lost. Muscle, tendons, bones, or joints may be exposed, and yellowish necrotic tissue or eschar may be present at the wound base. Some signs of an infected stage 4 pressure ulcer include: – Thick, yellow or green pus
Ngoài phân cấp độ như trên, các bác sĩ cũng có thể đánh giá mức độ loét tì đè dựa trên một số tiêu chí:
– Nghi ngờ tổn thương mô sâu: Vùng khu trú da đổi màu tím đậm hoặc nâu đỏ, có các phỏng nước chứa máu do tổn thương mô mềm bên trong, chịu lực trượt hoặc lực ép. Vùng da này có thể mềm, nhão hoặc cứng; chạm vào thấy đau, nóng hoặc lạnh bất thường hơn so với vùng da khỏe mạnh xung quanh.
– Không xếp loại được: Là tình trạng vết thương tì đè đã bị mất toàn bộ mô, nền vết thương bị che kín bởi các lớp vảy là các lớp mô hoại tử hoặc tế bào chết (có màu đỏ nâu, xanh, vàng, xám…). Đáy vết thương có thể có eschar màu nâu, đỏ nâu hoặc đen. Cũng có trường hợp không thể thấy rõ được ổ loét sâu đến mức độ nào.
3. Prevention and Treatment of Pressure Ulcers
Treating pressure ulcers is costly and time-consuming, posing a burden on the healthcare system and significant pressure on both patients and caregivers. Therefore, prevention is extremely important. In cases where pressure ulcers have already formed, early treatment is essential to prevent wound progression and infection.3.1. Preventing Pressure Ulcers
The first important step in prevention is identifying individuals at risk and implementing appropriate preventive measures. According to clinical studies, the prevalence of pressure ulcers ranges from 3% to 30%, and they are commonly found in: – Patients with hemiplegia or paraplegia due to stroke.– Patients on mechanical ventilation, receiving oxygen therapy, in a coma, or bedridden for prolonged periods.
– Elderly individuals with fractures, poor health, mobility difficulties, confined to wheelchairs or bedridden for extended durations…
For individuals in the above risk groups, regular assessment and creating an environment that promotes soft tissue integrity is essential, by: – Using proper positioning techniques: When repositioning, do not drag the patient off the bed or wheelchair. Instead, lift them to avoid friction that could damage the epidermis. Additionally, to limit shearing forces, caregivers should avoid elevating the upper body more than 30 degrees. – Using support surfaces: Certain beds, mattresses, and specialized mechanical devices can help prevent pressure ulcers. Caregivers may use seat cushions, sheepskin pads, foam or gel mattresses to protect high-risk anatomical areas. Moreover, replacing standard mattresses with air-fluidized or alternating pressure mattresses helps distribute body weight evenly, thereby reducing pressure points. However, it’s important to note that no single support device is fully effective in preventing pressure ulcers, and they cannot replace essential nursing care. Besides these two methods, patients should receive regular skin assessments by medical staff to detect early signs like skin redness. Additionally, proper nutrition is vital to prevent deficiencies, and hygiene care should be emphasized, including: – Carefully caring for the skin and keeping it clean and dry.
– Preventing contamination of the genital, pelvic, and urinary areas with waste.
– Massaging high-risk areas at least 3–4 times daily.
– Ensuring bed linens are always clean, dry, and wrinkle-free to avoid additional skin pressure.
🡺 Regarding doctor-recommended products for pressure ulcer prevention, one must mention Sanyrene – The New Generation Pressure Ulcer Prevention Spray from Urgo Medical. Its formula includes essential fatty acids that enhance oxygen supply to pressure-prone skin areas while improving skin hydration and elasticity. This helps protect skin integrity and prevents pressure ulcer formation.
To achieve optimal preventive effects, Sanyrene acts on at-risk skin areas through two mechanisms:
– External action:
Supplies essential fatty acids—key components of the skin structure → Restores the function of the stratum corneum and epidermis → Enhances skin elasticity, prevents dehydration, and maintains moisture.
– Internal action:
Delivers 99% highly oxidized essential fatty acids → Provides a foundation for key biological reactions → Boosts skin regeneration and improves blood circulation.
Notably, the effectiveness of Sanyrene in preventing pressure ulcers has been clinically proven with outstanding results:
– GIPPS Clinical Trial:
Reduced the risk of pressure-related skin damage by 40%.
– Clinical Trial at Da Nang Hospital:
Saved 67% of total costs compared to pressure ulcer treatment.
The product is now available at over 2,000 pharmacies nationwide and is widely used in more than 150 hospitals across the country for patients at risk of developing pressure ulcers.
You can learn more about Sanyrene here.
3.2. Treatment of Pressure Ulcers
If pressure ulcers are still at Stage 1 or 2: the wounds do not require surgery and can be managed with conservative care. However, if the ulcer has penetrated into the subcutaneous tissue at Stage 3 or 4, treatment may require surgical intervention in combination with conservative methods (especially if the patient has comorbidities).
In general, treatment should begin as early as possible, but must strictly follow the physician’s prescribed protocol. Family members should not apply topical medications, ulcer treatments bought over the counter, or follow non-expert advice.
Below are commonly applied treatment methods for pressure ulcers, either in combination or individually, depending on the patient’s condition and the severity of the ulcer:
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Supporting the patient’s overall condition
– Pain management.
– Managing incontinence.
– Properly cleaning the pressure ulcer and surrounding skin.
– Providing a balanced diet to boost immunity.
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Reducing pressure on the patient’s skin
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Proper wound care
– Clean the pressure ulcer using normal saline, 2.5% sodium hypochlorite, diluted povidone-iodine, or 0.5% acetic acid.
– Apply dressings to promote wound healing by maintaining moisture, keeping surrounding skin dry, and controlling exudate.
– Other methods: Negative pressure wound therapy, hyperbaric oxygen therapy, growth factors, electrotherapy…
– Spray Sanyrene on the surrounding skin to prevent ulcer expansion.
* Regardless of the method used, caregivers must strictly follow the physician’s instructions.
3.3. Nutrition for patients with pressure ulcers
Malnutrition is one of the key risk factors that slows the healing process in patients with pressure ulcers. Therefore, caregivers should focus on creating a proper nutrition plan that ensures a balance of essential nutrients, including protein, calories, vitamins, and trace elements (minerals). Specifically:– Minerals: Copper, iron, and zinc are trace elements associated with wound healing.
– Vitamins: Vitamins A, E, C, and K help enhance immunity and accelerate wound healing—particularly vitamin C.
Additionally, during pressure ulcer care, it’s important to monitor wound exudate levels and adjust the diet accordingly. Patients should also be advised to:
– Avoid smoking
– Avoid alcohol consumption
– Limit staying up late
– Strictly adhere to treatment plans and use anti-ulcer medications or topical treatments as prescribed by the doctor
When suffering from pressure ulcers, patients experience not only physical pain but also emotional distress, including feelings of inferiority, depression, and social isolation… Therefore, caregivers need to be mentally and intellectually prepared to support the patient’s recovery and improve their quality of life. When it comes to pressure ulcers,
the best treatment is to prevent them from occurring in the first place.
For those in high-risk groups, the focus should be on maintaining intact and healthy skin.
Among available options, Sanyrene is a specialized product widely used in hospitals across the country for the prevention of pressure ulcers, thanks to its effectiveness, affordability, and ease of use.
- Khảo sát nguy cơ loét tì đè và các yếu tố liên quan trên bệnh nhân nội trú tại Khoa hồi sức tích cực Bệnh viện Thanh Nhàn: https://sti.vista.gov.vn/tw/Lists/TaiLieuKHCN/Attachments/307714/CVv417S502019134.pdf
- Giải pháp dự phòng loét tì đè trên người bệnh tại phòng hồi sức khoa nội – hồi sức thần kinh Bệnh viện Hà Nội Việt Đức – 2016: http://safevietnam.org.vn/Images/FileAttach/loet.pdf
- https://familydoctor.org/condition/pressure-sores/
- https://msktc.org/sci/factsheets/skincare/Recognizing-and-Treating-Pressure-Sores
- https://www.vinmec.com/vi/tin-tuc/thong-tin-suc-khoe/suc-khoe-tong-quat/cac-giai-doan-phat-trien-cua-loet-do-ti-de/
- https://www.vinmec.com/vi/tin-tuc/thong-tin-suc-khoe/suc-khoe-tong-quat/xu-ly-loet-do-ty-de/
- Theo MSD Manual – Phiên bản dành cho chuyên gia: https://www.msdmanuals.com/vi/chuy%C3%AAn-gia/r%E1%BB%91i-lo%E1%BA%A1n-da-li%E1%BB%85u/lo%C3%A9t-t%C3%AC-%C4%91%C3%A8/lo%C3%A9t-t%C3%AC-%C4%91%C3%A8#v8381516_vi
8.https://www.vinmec.com/vi/tin-tuc/thong-tin-suc-khoe/suc-khoe-tong-quat/xu-ly-loet-do-ty-de/#:~:text=M%E1%BB%A5c%20%C4%91%C3%ADch%20ch%C3%ADnh%20c%E1%BB%A7a%20%C4%91i%E1%BB%81u,peroxit%20hydro%20v%C3%A0%20povidon%2Diod.