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Decubitis Ulcers (Pressure Wounds or Pressure Sores), the Cause and the Cure

Updated on July 27, 2009

What Are Decubitis Ulcers?

 Most people know decubitis ulcers by other more common names, such as bed sores, pressure sores, or pressure wounds.  Whatever you call them, they are painful and dangerous.

Decubitis ulcers most often occur when someone has been bedridden for a period of time or remains in one position pressing bone against the tissue between it and the epidermis over time.  The pressure stops the free flow of blood in that area.  Eventually, the skin and tissue will begin to break down.  A decubitis ulcer will form.

Most practitioners who have cared for the elderly or the disabled are familiar with these sores.  While hospitalization is possible in the short term, most hospitals and doctors will send the patient home for care as it can take months for a wound of this nature to heal under the best of conditions.

How to Create an Ulcer

Simple pressure as indicated in the picture can cause a decubitis ulcer over time.
Simple pressure as indicated in the picture can cause a decubitis ulcer over time.

Example of Ulcer Creation

The photo to the right gives a good example of how an ulcer comes about. 

Hold your right wrist between you thumb and forefinger as shown.  Do not press hard.  Just apply enough pressure so the wrist can feel the touch.  Hold it for five minutes or ten minutes or thirty minutes.  The longer you can hold it the better.

When you remove you fingers from the wrist you will notice that the area of skin looks white.  Blood has not freely circulated due to the small amount of pressure that was applied.  This example takes only a few minutes.

Now, think of a patient who may be bedridden and unable to move on his or her own.  They may lay in one position for an hour or two or eight or maybe all day and all night.  During that time blood is resticted, especially in the areas where joints press against the skin.

Over time, if left in one position, the body tissue begins to break down and a decubitis ulcer will form.

Why Didn't We See the Ulcer Before It Was So Big?

One misconception that many people have is that we should see these decubitis ulcers as they develop.  Often, we blame the caregivers for not seeing the development stages of a pressure wound or bed sore.  Perhaps, the caregiver should have moved or turned the patient more frequently, but they did not see it coming.

Decubitis ulcers develop under the skin in the soft tissue we cannot see.  During the development period these wounds "tunnel" under the skin, filling the tunnels with pus and infection.  It is virtually impossible to detect an ulcer before it "breaks through."

Once an ulcer has done sufficient damage (tunneling) under the area where blood flow has been restricted, it breaks through the outer skin.  In fact, an ulcer can appear within a matter of hours, full blown, already fully developed.

Stage IV Decubitis Ulcer

This is a Stage IV decubitis ulcer that appeared within 24 hours.  The tissue is already necrotic as it hangs from the wound.    Chances are there would have been a better chance of detection hours earlier but this particular patient is a quadriplegi
This is a Stage IV decubitis ulcer that appeared within 24 hours. The tissue is already necrotic as it hangs from the wound. Chances are there would have been a better chance of detection hours earlier but this particular patient is a quadriplegi

What Is the Best Cure for a Decubitis Ulcer?

Needless to say there are many applications used today for healing these dangerous ulcers. There are prescription ointments that can be applied daily or every other day. There are natural remedies that work as well and in some cases even better than prescriptions. For applications and ointments it is always best to consult a medical doctor, although I must confess that many have been more than impressed by home remedies.

Occasionally, surgical debridement is required.  For Stage I or Stage II and some Stage III decubitis ulcers, debridement is most often the result of topical care given by a wound care nurse, and occurs naturally over time.

However, the long range cure for a decubitis ulcer is proper nutrition with a high protein diet. I am not by any means dismissing the need to topical treatment. However, once the skin has begun to break down, proper nutrition is the only way to rebuild the cells.

A balanced diet is a good place to start. Ensure of Boost supplements fortified with protein will help. The patient's diet should include at least 60 grams of protein a day. While this may seem a bit high to most of us, a high protein intake will do more to cure the tissue as it rebuilds than anything else.

Again, we are not dismissing the need to keep the wound clean and drained or to use the topical creams and ointments as prescribed. However, without a high protein diet all the topical ointments in the world will do little to facilitate the healing of the wound or to prevent other ulcers from occurring.


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    • lewisrl205 profile image


      8 years ago from Tuscaloosa, AL

      For more info on how these painful ulcers can be healed check out


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