Skin Care and Pressure Sores

Skin Care Management
Poor circulation below the waist means that the cells don't get adequate supplies of oxygen and nutrients to keep them healthy. Nor do their get rid of all their waste products. The lymphatic system works together with the circulation to remove fluid and waste products. This also does not work as efficiently in people with spina bifida as it should. The build-up of fluid in the legs is called oedema. 
All these things combined mean that pressure sores can develop very rapidly and then be very slow to heal.
Neurological (nerve) problems associated with spina bifida and the resulting loss of feeling means that little or no discomfort is felt and therefore there is no trigger telling you to move and reduce the pressure on a particular part of the body.
Incontinence will cause the skin to become even more prone to damage as both urine and faeces contain substances that break down the skin and cause it to become infected.
A good balanced diet, with plenty of fruit and vegetables is invaluable for prevention and healing. An adequate intake of fluids to hydrate the skin is necessary and extra Vitamin C and Zinc aids the healing process. 
Skin should be regularly inspected as part of a regular care routine, using a long-handled mirror to view hard to see parts of the body. In case of incontinence 'accidents', wash and dry skin as soon as possible. Wheelchair users should relieve pressure on the buttocks by lifting the bottom every twenty minutes or at the very least, change position. Change position of feet frequently. Wear suitable clothing - no tight clothes, hard seams, zips or buttons that could cause pressure sores. Wear shoes that fit properly. Make sure that the wheelchair cushion is suitable - seek advice from Occupational Therapist, Physiotherapist, or Seating Clinic. Protect skin when transferring and finally, protect skin from burns and frost-bite.
Skin Care Management - Children
Parents of young children should check their skin daily for any signs of redness especially the back and buttocks area, and potential pressure points from shoes or calipers. Change, wash, and dry as soon as possible if the child is wet or soiled.
Pressure Sores
A pressure sore is a sore on an area of skin where there is continuous heavy pressure, leading to a reduced flow of blood to the area causing tissue to erode and die. People with spina bifida, especially wheelchair users, are prone to developing pressure sores because of de-sensitive skin, paralysis, or scoliosis.
Sores usually occur at the site of a bony prominence or where there is pressure and or tension and a reduced flow of blood. They are mostly in the lower part of the body, especially on the buttocks and limbs. These also appear on the feet as a result of badly fitting shoes and calipers. Wet skin is more likely to break down than dry skin, i.e. where urine or sweat is present on the skin.
Causes of Pressure Sores
  • Immobility
  • Poor diet
  • Incontinence
  • Poor blood supply and oxygen to body tissue (Arterial Disease)
  • Weight gain
The Four Grades of Pressure Sores
  • Red patch, warm to the touch which blanches when pressed. This then progresses on to the next stage.
  • When the lesion is red, it does not blanch and is cool to the touch.
  • Pustular formation with oozing and broken skin
  • Surface crusting with deep tissue damage 
  • Lift your bottom from your chair every 20 minutes
  • Change the position of your legs at the same time
  • Check your skin all over at least once a day (twice is better)
  • If you are wet or soiled, the quicker you clean up and change, the better
  • Take care when transferring from your wheelchair
  • Eat a good balanced diet including a variety of fruit and vegetables, and drink plenty of clear fluids

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