Pressure sores can have serious, long-term implications if left untreated, but today’s advanced technologies work to reduce and alleviate their symptoms.
Pressure injuries, also known as pressure sores or pressure ulcers, are areas of damaged skin caused by a lack of blood flow to a part of the body that experiences prolonged pressure. Extended periods of pulling, friction and moisture on a person’s skin create a perfect storm of conditions for a pressure sore to develop.
The first sign that an injury has occurred is a warm area of red, spongy or hard skin, eventually contributing to a physical break in the skin’s surface. Reduced blood supply causes the skin to become damaged or die, leading to further injury.
Wheelchair users or people who are confined to a bed for extensive periods of time are more likely to develop pressure sores. These injuries can quickly become serious or life-threatening, and cannot be left untreated.
Fortunately, ongoing research and technological innovations are together advancing the knowledge and tools available to alleviate, reduce and prevent this common problem. Pressure imaging systems are one important advancement that can make a world of a difference for patients suffering from pressure injuries.
Pressure Sores: The 4 Stages of Pressure Sores
Understanding how pressure injuries develop is key to preventing and mitigating them. The National Pressure Ulcer Advisory Panel describes the four stages of pressure injury development as follows.
Stage I – Non‐blanchable Erythema: "Intact skin with non‐blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate ‘at risk’ persons."
Stage 2 – Partial Thickness: "Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough [dead tissue]. May also present as an intact or open/ruptured serum‐filled or sero‐sanguinous [serum and blood] filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising [bruising indicates deep tissue injury]. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration [damage through the skin being wet] or excoriation [damage through scratching/abrasion or burns]."
Stage 3 – Full Thickness Skin Loss: "Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunnelling. The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput [back of the head] and malleolus [ankle] do not have [adipose] subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable."
Stage 4 – Full Thickness Tissue Loss: "Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar [scabbing] may be present. Often includes undermining and tunnelling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have [adipose] subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g. fascia, tendon or joint capsule) making osteomyelitis [bone infection] or osteitis [inflammation of bone] likely to occur. Exposed bone/muscle is visible or directly palpable."
What are pressure mapping systems?
Appropriate tools can provide healthcare professionals with the information they need to evaluate and treat their patients effectively. Pressure mapping technology offers more detailed information about a patient’s condition than a physical exam alone will reveal. The tool itself can be as simple as a mat with sensors placed on a patient’s seat cushion or bed. When activated, the system provides live information about the points of pressure beneath the surface of the skin. These points are accurately measured and categorized by color, with light blue signifying low pressure and red alerting to high pressure.
Understanding a patient’s current skin pressure equips clinicians to run immediate interference on developing injuries before they become serious. Pressure mapping also notifies us about the areas most affected, allowing caregivers to focus their efforts and work efficiently in alleviating symptoms.
When would you want to use a pressure mapping system?
Pressure mapping systems have traditionally been used for research purposes, and are patient assessment. Understanding the pressure points of each unique patient helps healthcare professionals to educate the wheelchair user on skincare and to design an individual care plan with informed decisions about bed and seating surfaces.
It’s important to remember that with pressure injuries, once the skin breakdown occurs, it takes a long time to heal. Understanding where pressure is located before it becomes a problem allows clinicians to redistribute it early. This pressure information can be shared with family members and other caregivers, equipping them with the knowledge to advocate for appropriate patient care when the primary caregiver is not present.
There are several specific scenarios where a pressure mapping system would be particularly beneficial. These include:
Persistent Pressure Injury: Where injury occurs repetitively, a pressure mapping system can identify the exact point where pressure will occur before it appears and identify the source of the problem. Because the map shows the exact location of highest pressure, the position of the seat cushion can be altered or modified—and verified—for better pressure distribution.
Bio Feedback: Pressure mapping systems offer instantaneous feedback through pressure readings after a position has been altered, allowing clinicians to test different positions while viewing live results, revealing how much movement is required to reduce the possibility of further injury.
Poor Tissue Integrity: If a patient has been recently diagnosed with an illness that may compromise tissue integrity, a pressure mapping system can determine areas of higher pressure that are susceptible to skin breakdown.
Lack of Sensation: A patient that lacks sensation in a particular area of their body (for instance, someone affected by multiple sclerosis) is at higher risk for pressure injuries. A pressure map allows professionals to create a skin protection cushion that is suitable to their unique needs for invaluable pressure relief.
Equipment for relieving wheelchair pressure sores
XSENSOR’s wheelchair seating system offers an effective solution for clinicians designing seating solutions for preventing pressure injury for wheelchair users. Our ForeSite SS system is the most advanced pressure mapping technology on the market, combining top-tier sensor accuracy and high-resolution images with easy-to-use software. The result is a conformable, effective sensor pad that measures skin pressure, helping to manage existing injuries efficiently—or prevent them from developing in the first place.
The right equipment, combined with appropriate lifestyle changes, can help to alleviate, reduce and eliminate pressure injuries — especially for wheelchair users. To integrate XSENSOR’s dynamic sensing technology into your patient care, contact us today.
