What is a bedsore?

In France, the prevalence of pressure ulcers in hospitalized patients is estimated at 9%. This scourge, which seems inevitable in prolonged feeding, still has no established treatment. We will explain the mechanism of pressure ulcer formation and treatment in places.

An eschar is a cutaneous lesion of ischemic origin, that is to say due to a lack of blood supply. It is also called bed sore or bed sore depending on the country. This wound that never seems to heal is the consequence of the prolonged support of a tissue against a surface. For example, if you have been bedridden for a long time (or for people in wheelchairs), the permanent contact of the flesh against the bed (or the chair) will gradually compress the blood vessels and thus reduce the intake of blood. The tissues will start with necrosis in depth, then gradually this hypoxia will spread and rise to the surface. In general, an eschar will appear to the bony prominences where the pressure is stronger. It begins with a zone of persistent redness (stage 1), then induration of the skin with the progressive appearance of blister (stage 2) and then appears the wound with necrosis of the skin (stage 3). From that moment, it is very difficult to backtrack and surgery becomes almost inevitable. In the most severe cases, there is a stage 4 and 5 where the area of ​​the ulcer widens more and more.

Etiology of pressure sole
Why does not an eschar manage to heal?

The first reason for the difficulty in treating a bedsore is that the patient often has to stay in bed. The ulcer is a secondary consequence and it is often not possible or possible to put the patient in another position.

Then you have to understand the mechanism by which a wound can heal. Good healing is none other than the normal development of cells, whether we are talking about skin cells, muscles or other cells, we must allow proper cellular development. If the cells multiply quickly under good conditions, then healing can be done. So let’s see the needs of a cell to multiply without problem, to help us we will compare a cell to a baby.

To grow up, a baby must be fed, a cell must be vascularized. The child needs to drink, a cell needs to be hydrated. He must breathe and the cell must be oxygenated. It does not need chemicals, ditto for the cell. Finally, it must be in a clean and healthy environment without aggressive factors.

In order for a wound to heal, it is necessary to allow the vascularization by limiting the compression, to moisturize it abundantly, to oxygenate it to a maximum, thus avoiding too thick dressings which do not let air pass and especially to avoid the overabundance of products. medicated chemicals that disrupt the proper cellular development.

A final point comes to complete this list, it is the extra-cellular matrix (ECM). What exactly is this matrix? The MEC is also intercellular is the medium on which a cell will grow. It basically consists of proteins in all genres, you have already heard of some things that between the collagen or elastin that gives the appearance of elastic to our skin. Well, know that there is a multitude of other proteins in this matrix, including a particularly interesting family in our case: metalloproteases (MMPs).

MMPs are enzymes that are able to degrade the constituents of the extracellular matrix. Normally, they can destroy damaged parts or injured parties to allow other actors to synthesize a new matrix. For healing to proceed normally and quickly, a balance must always be maintained between MMPs and their inhibitors TIMP (for tissue inhibitor of metalloproteases). When the concentrations of MMPs become higher than those of TIMPs, there is a delayed healing or no healing!

When an eschar appears, there will be a significant inflammatory phenomenon that will disrupt the action of TIMPs. MMPs will soon take over and continue to degrade more and more the MEC. The cells can not multiply and the wound remains chronic.

If other factors we saw earlier in this article enter, lack of oxygenation, poor hydration of the wound or the application of chemical antiseptic products, it is impossible for the wound to heal on its own .

How to cure a bedsore

Naturveda has developed Antiscar, a natural treatment for pressure ulcers. Click this link for more information.
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Références

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Xie, X., Bao, Y., Ni, L., Liu, D., Niu, S., Lin, H., … Luo, Z. (2017). Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner’s Grades, IDSA/IWGDF Grades, and Ulcer Types. International Journal of Endocrinology, 2017, 1–12.
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Lee, Y.-B., Kim, D.-H., Jung, J.-H., & Park, J.-Y. (2017). Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap. BioMed Research International, 2017, 1–5.
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Everts, P. A., Warbout, M., de Veth, D., Cirkel, M., Spruijt, N. E., & Buth, J. (2017). Use of epidermal skin grafts in chronic wounds: a case series. International Wound Journal.
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Kim, S., Kim, J. H., Choi, J., Jeong, W., & Kwon, S. (2017). Polydeoxyribonucleotide (PDRN) Improves Peripheral Tissue Oxygenation and Accelerates Angiogenesis in Diabetic Foot Ulcers. Archives of Plastic Surgery. https://doi.org/10.5999/aps.2017.00801

Waycaster, C., Carter, M. J., Gilligan, A. M., Mearns, E. S., Fife, C. E., & Milne, C. T. (2017). Comparative cost and clinical effectiveness of clostridial collagenase ointment for chronic dermal ulcers. Journal of Comparative Effectiveness Research, cer-2017-0066.
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Chodkiewicz, H. M., Greenway, H. T., & Housman, L. (2017). Successful Treatment of a Scleroderma-Associated Leg Ulcer With Endovenous Laser Ablation. Dermatologic Surgery, 1.
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