Spinal Cord Paralysis and Skin Problems

People with spinal cord paralysis are at high risk for skin conditions known as pressure ulcers or bedsores . Decreased mobility and impaired sensation can lead to pressure ulcers, which are a serious problem.

The skin, which is the largest organ of our body, is normally flexible and robust. It acts as a barrier between the outside world and the body; It protects the deep tissues from factors such as air, water, foreign bodies and bacteria. Although there is a risk of injury, it has a high self-healing capacity.

Decubitus or bedsores can range in severity from mild redness to deep pits reaching the bone. It starts as a persistent redness, and if neglected, the formation of blisters on the skin, peeling, deterioration of skin integrity, exposure of subcutaneous tissues, and deepening to muscle and bone can progress rapidly. When the skin is subjected to constant pressure, the blood vessels that carry oxygen and nutrients to the skin are compressed. When they cannot get the nutrients and oxygen they need, tissue death begins and bedsores occur.

What Causes Bed Sores?

Staying in the same position for a long time in a bed or chair weakens the skin. Sliding on the bed, squeezing the hard faces of orthoses such as AFO, friction of the skin during the transition to a wheelchair can cause wound dehiscence. In addition, people with spinal cord injury experience loss of sensations such as touch, pressure, heat, pain, and the risk of burns increases.

Bed sores first start from areas such as the hip, coccyx, and heel, where the bones are close to the skin. This is caused by the skin being pinched between the bone and the outer surface.

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The inactivity of the paralyzed person causes a decrease in blood circulation, the amount of oxygen going to the skin decreases and the resistance of the skin decreases. In response, the body tries to send more blood to that area; This may cause edema and further increase tissue pressure.

How Does Bed Sores Occur?

Bed sores first start out as a red area on the skin. The reddened area may feel hard and hot to the touch. In dark-skinned people, the affected part may appear shiny. At this stage, the problem is reversible. If the pressure is removed, the skin may return to its normal color. If pressure continues, bubbles or crusts form. This means that the underlying tissue is dying. All pressure must be removed immediately.

If the wound progresses, a pit (ulcer) is formed in the dead tissue in the next stage. Sometimes this dead tissue covers a small area on the surface, but can expand deeply, even reaching the bone.

If bedsores occur, the person may need to be hospitalized or rested for weeks or months for the wound to heal. If the wounds are so deep and wide that they cannot heal on their own, surgery is performed. All these impede recovery and are a huge financial burden for the health system. However, it is possible to prevent most bedsores by paying attention to a few simple points.

Prevention and Treatment

Infection, spasticity, psychological problems may increase the risk of pressure ulcers. It may not be possible to prevent pressure ulcers 100 percent, but with careful skin care and cleaning, it can be prevented almost completely by giving importance to position change.

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The skin of people with spinal cord palsy should be carefully examined every day. A healthy diet, hygiene and regular repositioning help keep the skin healthy. The fact that the skin is constantly wet due to perspiration reduces its fragility, so care should be taken to stay dry. If the wound has been opened, there may be significant fluid loss through evaporation from that area, in such a case it may be recommended to drink plenty of water. In order to minimize the risk of bedsores, the person should pay attention to being at a normal weight. Being too thin thins the fat layer between the bones and the skin, so even small amounts of pressure can cause skin damage. Being overweight is inconvenient as it means more burden. Smoking negatively affects blood circulation and wound healing, so smoking should be avoided.

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