Causes and diagnosis

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• My mother had a leg ulcer, will I get one?

A number of well-known acquired and putative inherited etiological factors such as venous insufficiency, obesity, and deep vein thrombosis can contribute to the development of venous leg ulcer. These factors can be prevented. Your clinician can  give you advice.

• Why did my mother develop a pressure ulcer/bed sore?

Pressure ulcers are developed because the mechanical load (pressure) on the tissue is higher than the tissue can resist. You can feel the mechanical load on the tissue while sitting or sleeping in the same position for a long time. This causes pain and you can feel so uncomfortable that you need to change your position. However, someone who is very ill, has loss of sensation or who cannot move, cannot change their position and thus are at an increased risk of developing a pressure ulcer. The main risk factors for pressure ulcers are immobility, increased skin moisture (incontinence, sweating, highly exudating wound) and poor nutritional status.  Other factors also increase risk but these are the main ones.

• Are pressure ulcers/bed sores inevitable when someone is confined to bed?

No. In most cases, pressure ulcers can be prevented. The risk factors need to be recognised before the pressure ulcer develops and to do this clinicians  are recommended to use a risk assessment scale. It is also important that the individual at risk changes positon in bed by him/herself or with help to relieve pressure. For individuals who are confined to bed it is very important to inspect the skin at least daily, have a strategy to re-position and if necessary to use a special mattress to relieve the pressure.  

• I have diabetes. Is developing a diabetic foot ulcer inevitable?

No. Individuals who develop a diabetic foot ulcer usually have a long history of diabetes or very poorly controlled diabetes. As a progressive disease, diabetes causes complications, like neuropathy (reduced sensation in the feet) and/or arterial-vascular disease that disturbs normal arterial blood flow in the  foot. Together with trauma, these changes could mean that even a minor break in the skin may lead to the development of a diabetic ulcer.

It is very important that you manage your diabetes well, so that the risk of developing complica-tions is reduced.  The daily care and inspection of your feet is important to ensure that any changes in the skin are noticed and that the skin is kept healthy.   

• My doctor says I suffer from venous insufficiency. Is it inevitable to develop a leg ulcer?

No. Venous insufficiency cause oedema (fluid) in the tissue and this increases the risk of developing an ulcer. Thus it is very important to use the prescribed compression therapy and exercise to strengthen the muscles in the calf. The exercise will also support the venous circulation and help decrease and prevent oedema. The general practitioner can assess the seriousness of venous insufficiency or refer to a clinician with expertise in venous leg ulcer assessment. Surgical treatment may be needed in some cases.

• I heard my nurse talk about pressure sores/bed sores categories/stages. Do I need to worry?

The pressure ulcer categories are used to assess the severity of a pressure ulcer. The categories explain how deep the ulcer is and provide important information for professionals concerning the treatment plan. The categories which are typically used are the EPUAP/NPUAP pressure ulcer categories (www.epuap.org ):

“Stage 1:  Non blanchable erythema” means that there is no ulcer, but the skin is red in colour. The ulceration can be prevented by good skincare and positioning, and pressure releasing mattresses are recommended.

“Stage 2: Partial Thickness Skin Loss” means that the skin is broken, but the damage is superficial and the healing prognosis is good if appropriate wound care, positioning and use of a pressure releasing mattress are applied.

“Stage 3: Full Thickness Skin Loss” means that the wound is deeper than in Stage 2, extending to the subcutaneous layer which is also called fat tissue. The risk of infection is high and the ulcer may need examination by a surgeon.

“Stage 4: Full Thickness Tissue Loss” means that the ulcer extends into the muscle or even into the bone or joint. Consultation with a surgeon is needed and often these Stage 4 pressure ulcers are treated by a plastic surgeon.

• I heard my nurse/physician talk about stage/classification of my wound. What does that mean?

Staging/classifying of a wound means to categorise your wound. The categorisation is based on the etiology, such as diabetic foot ulcer, pressure ulcer or venous leg ulcer. The categorisation is only part of the total assessment of your wound, which includes other factors such as surrounding skin and presence of exudate, to name a few. Details about pressure ulcer categories are provided in the answer to the above question.

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