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Ask the Medical Expert Archives 2000-2004

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Bed Sore Not Healing
September 2000

Q. My mother has a bed sore about as large as a silver dollar. She hasn't been laid on this side for at least two months yet the sore will not heal. It is kept clean and we have tried various ointments per her doctor. Nothing helps. Do you have any ideas?

A. Chronic skin ulcers are a common problem, especially in the elderly, bed-ridden patients. Prolonged pressure on an area of the skin is one of the major risk factors for decubitus ulcers. This is due to impaired blood circulation to that area chiefly from the pressure. The skin initially turns red, then eventually often breaks down further. Shearing forces are also a factor. Therefore, it is very important to reposition immobilized patients frequently and carefully to help reduce the risk of skin ulcer formation. However, despite these precautions, as it sounds like you have been doing, it is still possible for ulcers not to heal well. Another important factor is adequate nutrition, in particular protein. Adequate serum blood protein is important in the ulcer healing process. Various immunity, and metabolic factors are also important. For example, diabetics are at a much higher risk of skin ulcers and they can also be very difficult to heal.

Fortunately, there are several different treatments available, which are too numerous to list here, but it sounds like several have been already tried. What I would suggest, if not done yet, is to have your mom seen by a specialty wound clinic. Your mom's doctor hopefully could refer you to one locally. Those clinics should be aware of the latest treatments available and can help further guide you.

Also, research continues to advance, and in fact I believe very soon there will be new treatment approved for diabetic skin ulcers called Dermagraft which is derived from living human fibroblast cells. A fascinating advancement, which eventually may be available for non-diabetic ulcers as well.

Good luck.

References: http://www.woundtx.com/summaries/index.html

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