SHEARING FORCE AS A FACTOR IN DECUBITUS ULCERS IN PARAPLEGICS

TLDR

Severe decubitus ulcers in paraplegics arise from prolonged local circulation interference that causes massive tissue necrosis. The study aims to elucidate the mechanical factors that contribute to decubitus ulcer formation so that more effective preventive measures can be developed. Decubitus ulcers develop when skin and subcutaneous tissues are compressed between bone and a firm mattress, and in paraplegia the absence of pain prevents positional shifts, allowing prolonged pressure.

Abstract

Severe decubitus ulcers often result when a paraplegic is treated in a general hospital. Understanding of the basic mechanical factors involved may conceivably lead to more effective and widespread preventive measures. <h3>Compressive Force</h3> Massive tissue necrosis follows when there is interference with the local circulation of sufficient degree and for a sufficiently prolonged time for extensive irreversible tissue changes to take place. This may result from compression of the skin and subcutaneous tissues between unyielding bone on one side and firm mattress on the other, as shown in the figure, part A. In the presence of normal tissue sensitivity such compression, after a time, produces discomfort, whereupon the conscious patient shifts his position or asks to be moved. Even during sleep, sensations from the skin cause slight changes in position.¹Where the tissues are anesthetic, as in paraplegia, the patient feels no pain and is more or less dependent