A pressure injury is a wound caused by constant pressure on the skin. As a person with a spinal cord injury (SCI), the risk of getting a pressure injury is very high. Pressure injuries can develop in just a few days or even a few hours, they don’t heal like normal skin, and a person must stay off of it and clean/care for it daily. A pressure injury can occur from sitting in one position for too long or creating friction/shear when transferring/moving around.
Pressure injuries greatly affect how you live your life and can happen anywhere on your body. The most common places occur over bony prominences such as your tailbone, sitting bones, hips, elbows, ankles, and heels.
There are some things that you can do to prevent pressure injuries and keep your skin healthy. The first tip in prevention is to complete daily skin checks – do them first thing in the morning & at night before bed. Pay special attention to bony areas or areas that are reddened for more than 30 minutes. For those hard to see/hard to reach areas, you can use a long-handled mirror, or if possible, ask a caregiver/family/friend to help.
Another prevention tip is to perform weight shifts on a regular basis for blood to flow/circulate. If possible with your level of injury, a tricep push-up can be done to relieve pressure on your sit bones throughout the day. It is recommended to hold this tricep push-up for at least 10-15 seconds – or however long you are able and continue this for a minute or two, every 15 minutes. If a tricep push-up is not possible, leaning far forward or to one side can also provide pressure relief. If you are a power wheelchair user, you can use the tilt/recline function to temporarily relieve pressure from sitting. When lying in bed, it’s important to turn from side to side every few hours. Pillows can be used to help with this.
Avoiding hard surfaces and always using soft padding under the parts of your body with reduced feeling is another suggestion for keeping your skin healthy. More prevention tips include keeping your skin clean & dry, using warm (not hot) water for bathing/showering, washing your skin daily with mild, liquid, unscented soap and using a soft towel to dry off, paying closer attention to areas where skin meets or where skin folds. Further, wearing loose, but fitting clothing and shoes can help prevent clothing from bunching which adds pressure to the skin. Clothing that is too tight can restrict blood flow, which can also lead to pressure injuries.
If you wear a leg bag, it is suggested to wear your leg bag on a different leg every other day to give your skin time to bounce back. Try to reduce friction and rubbing on harder surfaces, especially during transfers. This can create a “rug burn” type of pressure injury. Last but not least, eat a well-balanced diet and drink plenty of fluids. Higher protein intake will help your body heal, so if you are treating any
type of pressure injury, try increasing your protein to help with the healing process. Good sources of protein can be found in high-quality meats (chicken, turkey, pork, beef), tofu, tempeh, greek or plain yogurt, quinoa, chickpeas, beans, lentils, nuts/seeds, or adding protein powder to a smoothie.
Not all pressure injuries can be prevented but, there are some early warning signs that you can watch out for in order to address the area of concern as soon as possible. If you notice a well-defined red area – or blue area on darker skin – you will want to look for blanching. Blanching is when the area becomes pale when you press on it, and then slowly comes back to the red (or blue) color. If the area does not blanch, it is an early pressure injury. A pressure injury could also look like swelling or skin that feels full of fluid – this is sometimes called a deep tissue injury. Another type of early pressure injuries are blisters or broken skin. You will want to watch as this heals and try to keep all pressure off of it while it does heal. Make sure to clean and care for it daily as it heals. If you have any area of concern, it is recommended to seek medical attention as soon as you can.
Stages of a Pressure Injury
There are six stages of pressure injuries: non-blanching red spots (stage I), broken skin (stage II), deep sores (stages III and IV), unstageable, and deep tissue injury, where the depth of the injury is unknown. The longer the pressure injury goes untreated, the worse it will get and the harder it will be to heal.
If you have a warning sign, it is strongly recommended that you act right away. Do what you can at home like keeping pressure off the area until the skin returns to normal, check your skin regularly, and if the skin is broken or the redness does not go away after 24 hours – seek medical attention as soon as possible. A couple of tips of what not to do include massaging the area and applying heat as those can make the injury worse.
Surgical Treatment options
Sometimes surgery is needed in order for a pressure injury to heal. Debridement and removal of biofilm is a common procedure where dead cells and tissue is removed. Dead tissue can lead to infections and blocks healthy tissue from re-growing. This can be as simple as a vigorous scrubbing or may need to be performed by a surgeon in the operating room. Luckily dead tissue cannot feel pain so often debridement after SCI is often painless. Another common intervention is a skin and muscle flap procedure. It is a plastic and reconstructive surgical technique where tissue is removed from a donor site and moved to the pressure injury site with the blood supply intact. It’s used to fill a defect, or wound hole when the remaining tissue is unable to support a graft. If you do need surgery, there are hospitals around the country that specialize in these kinds of procedures so ask your medical team for guidance and recommendations.
Many other treatment options have been researched though some are still in development or not readily available. Appropriate cushion and mattress surfaces spread the weight over a larger area to prevent high pressure at the wound. These may be as simple as foam or as complicated as fluidized particle beds. Negative pressure wound therapy (aka wound vac) can help accelerate healing in large wounds. It draws off secretions and promotes good blood flow. Other techniques include electrical stimulation, biological maggot debridement, ultrasound therapy, or biological products (previously called skin substitutes).
While not all pressure injuries can be prevented, it is important to do what you can on a daily basis to protect your skin or take care of a pressure injury as soon as possible. Remember to complete pressure reliefs as often as possible, maintain a well-balanced diet with lots of water for hydration, complete daily skin checks, and seek medical attention if you have a concern. Set alarms for pressure relief and make skin checks and nutrition part of your daily routine.
