Bedsore are also called as pressure ulcers which start off as red pressure areas on skin due to prolonged pressure on a particular area of the skin. People who are at risk developing bedsore usually have limited mobility or spend most of their time in bed or chair. Bedsore can develop over hours or days of pressure applied on to the particular area of the skin; Most of them can be treated but if unattended can pose severe challenge to heal the wound.

Pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear is also a cause, as it can pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in individuals who are not moving about, such as those who are on chronic bed rest or consistently use a wheelchair. It is widely believed that other factors can influence the tolerance of skin for pressure and shear, thereby increasing the risk of pressure ulcer development. These factors are protein-calorie malnutrition, microclimate (skin wetness caused by sweating or incontinence), diseases that reduce blood flow to the skin, such as arteriosclerosis, or diseases that reduce the sensation in the skin, such as paralysis or neuropathy.

The healing of pressure ulcers may be slowed by the age of the person, medical conditions (such as arteriosclerosis, diabetes or infection), smoking or medications such as anti-inflammatory drugs. Although often prevented and treatable if detected early, pressure ulcers can be very difficult to prevent in critically ill people, frail elders and individuals with impaired mobility such as wheelchair users (especially where spinal injury is involved). Primary prevention is to redistribute pressure by regularly turning the person.

There are four mechanisms that contribute to pressure ulcer development:

External (interface) pressure applied over an area of the body, especially over the bony prominences can result in obstruction of the blood capillaries, which deprives tissues of oxygen and nutrients, causing ischemia (deficiency of blood in a particular area), hypoxia (inadequate amount of oxygen available to the cells), edema, inflammation, and, finally, necrosis and ulcer formation. Ulcers due to external pressure occur over the sacrum and coccyx, followed by the trochanter and the calcaneus (heel).

Friction is damaging to the superficial blood vessels directly under the skin. It occurs when two surfaces rub against each other. The skin over the elbows can be injured due to friction. The back can also be injured when patients are pulled or slid over bed sheets while being moved up in bed or transferred onto a stretcher.

Shearing is a separation of the skin from underlying tissues. When a patient is partially sitting up in bed, their skin may stick to the sheet, making them susceptible to shearing in case underlying tissues move downward with the body toward the foot of the bed. This may also be possible on a patient who slides down while sitting in a chair.

Moisture is also a common pressure ulcer culprit. Sweat, urine, faeces, or excessive wound drainage can further exacerbate the damage done by pressure, friction, and shear. It can contribute to maceration of surrounding skin thus potentially expanding the deleterious effects of pressure ulcers.

Bedsores can be treated by the following steps:

• Firstly, wash the wound bed with normal saline water thoroughly.

• Remove the dead skin cells which forms in the upper layer either physical debridement or using debridement ointments that contain urea and papain such as Synerzyme, which can effectively breakdown dead tissues

• Look for any infection like unusual changes in skin color or texture, Swelling or pus like drainage. This can be treated using an infection control gel like Nano Crystalline Silver gel which protect the wound from bacterial colonization and maintaining a moist wound environment that is conducive to healing.

• Or for infectious deep wound medicated collagen particles can be used as it promotes healthy granulation in infected deep wounds for early grafting and it is easy to apply and comfortable for better and more efficient wound coverage on irregular wound sites.

• Once the infection is removed dressing should be done according to the wound. If the wound is deep, collagen particles can be used; if the wound is flat collagen sponge or collagen sheet can be used for dressing the wound.

• Regularly change the dressing after 2 to 3 days.

• Collagen based particles/sponge are effective for regenerating normal tissues; once granulation tissues are formed, collagen gel can be used for faster epithelial formation.

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