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I also am a big believer in preventative measures. My mom has had slight pressure spots (red) but not any ulcers.
First, we use an alternating pressure mattress pad... One on her bed and one on the recliner in our living room where she hangs out during the daytime. We avoid the wheelchair for anytime over an hour, even with a nice pad, she gets red. My mom weighs under 75lbs. so she is boney.
We also make sure her skin is clean, dry, and lubricated with lotions and ointments/barrier cream. This requires frequent changing of her pad/brief.
We make sure to change her position every 1 1/2-2 hours. She always has a washable bed pad under her so a gentle hug and an adjustment to the hospital bed or recliner make this easy.
We check her entire body each morning and at bedtime for any areas of concern that need added attention...i.e. red spots. If she has any, we make sure to position her so it is not getting any pressure and we and medicated cream.
Finally, we add as much healthy fat and protein as we can in her diet. She takes in so little food at this point so we have to make each bite count. Protein helps keep the skin healthy.
I have heard that an open ulcer takes quite a while to heal. Just be diligent in keeping it clean and dry, keep cream/ointment on it, and keep the pressure off it as much as possible. Be sure to change her position so she doesn't form another by leaving her on one side too long.
A deep (stage 4) ulcer is very difficult and takes many, many months to heal and often leaves a scar.
There are also so many factors that contribute to effective or ineffective healing. Age plays a part. The older the patient, the less they move or want to be moved, the more chance they will get ulcers.
*Nutrition is a huge factor. Usually a high calorie, well balanced diet is ordered. It takes calories to heal.
*Positioning is another factor. Turning and repositioning the patient every 2 hours, keeping the patient off the ulcerated site helps to prevent the pressure that causes the lack of blood flow and tissue death, that causes bedsores.
*Treatments have ranged from massaging the area to create more blood flow, to removing the eschar (dead tissue that grows over the wound), to packing with medicated gauze or pouring granulated medicine into the wound. I believe hyperbaric oxygen chambers have also been used (concentrated oxygen).
Prevention is the best. Using protective devices, such as gel, air or foam cushions or mattress on any bony body part that comes into contact with pressure (arm of chair, seat of chair, shoulders, buttocks and heels on the bed) should be used.