Preventing Pressure Sores in Spinal Cord Injuries

Pressure sores are a frequent and serious complication of a spinal cord injury (SCI). They are an injury to the skin and underlying tissue usually caused by unrelieved pressure. A pressure sore can lead to serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis).

To help prevent pressure sores:

• Inspect your skin at least twice a day, especially around bony prominences such as along the spine, at the lowest part of the back (sacrum), around the hips, elbows, and knees, and the back of the head. Try to check whenever you change position. You may need a long-handled mirror or have to ask someone for help. Watch for:
  • Any area of skin where you previously had a pressure sore or other sore; scar tissue breaks down easily.
  • Redness, blisters, open sores, or rashes. If possible, use the back of your fingers to feel for heat in red areas.
• Keep your skin clean (free of sweat, wound drainage, urine, and feces). Use a mild cleansing soap to keep skin healthy, but be careful not to scrub the skin too hard.
• Keep your skin moisturized. Limit exposure to dry, cold weather. And use lotion to keep skin moisturized. Dry skin can become weak and vulnerable to pressure sores.
• Eat a healthy diet with enough protein to keep skin healthy and resistant to pressure sores and able to heal more quickly.
• Relieve pressure in bed. You will need pressure-relieving devices and supports and a turning schedule. You will need to turn every 2 to 5 hours, depending on body type. This includes at night. You can lie for up to 8 hours on your stomach with the correct support.
• Relieve pressure when you are in your wheelchair. Shifting your weight is most effective. You and your therapists will find the best way to do this. You can also use cushions, which provide pressure relief and weight distribution. Work with your therapists to figure the best cushion for you. Also:
  • Make sure the foot pedals of your wheelchair are adjusted to the right height for you. Having your foot pedals too high will put pressure on your hips. And having them too low can put pressure on the backs of your legs.
  • Sit up straight in your wheelchair. Slumping or slouching leads to added pressure over the end of your tailbone.
  • Try to lean to one side now and then to help relieve pressure.
  • Do a weight shift every 20 minutes.
  • Check your wheelchair cushions regularly for leaks, tears, or "flattened" gel (gel breakdown).
• Watch your clothing and accessories. Be sure your shoes are not too loose or too tight. Avoid tight clothing, clothing with heavy seams, and nylon underwear.
• Avoid smoking. Smoking dries out the skin and reduces blood supply to the skin, which can help pressure sores form and also slow the healing process.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Last Revised	February 16, 2011