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PRESSURE ULCER: THE CINDERELLA SKIN HEALTH CHALLENGE

Pressure Ulcers (PUs), commonly known as bedsores, are damages to the skin surface or underlying tissue due to a prolonged exposure to pressure. If someone is lying or sitting for an extensive time period without the possibility to reposition himself/herself, the prolonged interaction between the skin and the underneath surface can cause a breakdown, especially on a bony prominence.

In the year 2017/2018 the NHS Digital reported over 1,300 new ulcers PUs each month with up to 200,000 people affected. The economic burden of PUs is noteworthy. Indeed, it has been reported that the cost associated to the treatment and management of PUs is estimated to be more than £1.4 million every day. As well as being a financial burden to the healthcare system, PUs have also a huge impact on the quality of life of people. In fact, pain, recurrent hospitalisation and negative mood are among the consequences of dealing with this disorder.

WHO IS AT RISK?

No one is exempted from developing pressure ulcer. However, there are cohorts of individuals who are more vulnerable compared to others. These include elderly, especially those with impaired mobility, individuals with peripheral neuropathy, obese and bedridden individuals, and incontinent people.

SYMPTOMS OF PRESSURE ULCER

Early signs of PUs are associated with a discoloured red patch that do not turn white when pressed (non-blanchable erythema), pain or itchiness of the affected area. These symptoms define what is known as category one pressure ulcer. Later signs, instead, manifest as an open wound or blister (category two), a deep wound that reaches the deeper layers of the skin (category three), a very deep wound that may reach the muscle and bone (category four).

PREVENTION OF PRESSURE ULCERS

The prevention of PUs can be very difficult sometimes but there are various things one can do to lower the risk of them occurring. Among these:

  • Repositioning: it has been recommended that one should change position often in order to reduce and redistribute pressure. Bedridden people should change position every two hours.
  • Diet: a balance diet is known to be able to avoid individuals from developing various type of health complications. Indeed, a diet with the appropriate amount of protein and variety of vitamins and minerals can help prevent pressure ulcer development
  • Smoking: cessation of smoking is a necessity in order to prevent PUs from occurring. The reason being that nicotine, fundamental element in cigarettes, constricts blood vessels and a vasoconstriction of the skin results in reduced skin blood flow, hence skin damage
  • Skin check: constant control of skin status to point out early signs of PU is an important prevention approach.

PRESSURE ULCER MANAGEMENT

Sometimes PUs cannot be avoided, and, in these cases, it is necessary to adopt the optimal management strategy in order to improve the patient’s quality of life. These include:

  • Application of special wound dressings that aims at avoiding infection of the compromised area, redistributing pressure, and speeding up the healing process.
  • Regular physical activities and change of position
  • Use of moisturizers that have the same skin pH
  • Using specially designed static foam mattresses or cushions, or dynamic mattresses
  • Applying a high wound cleaning regime to avoid infection

CUTTING EDGE STRATEGIES FOR PRESSURE ULCER DETECTION

Despite all the effort promulgated in trying to avoid the continuous escalation of this skin disorder, PUs have proven to be very difficult to deal with. This is also due to the difficulties faced by clinicians to detect PUs relying only on their expertise and experience. So, it is not by chance that many research groups worldwide are trying to develop biophysical devices that can aid healthcare professional in accessing pressure ulcer this will enable the adoption of optimal prevention strategies. The outcome of these researches will not benefit only the NHS but also the patients and their families.

The new decade promises to be very interesting in the field of bioengineering for clinical application. Only time will tell how new discoveries will be able to impact the world. STAY TUNED!!!

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