Decubitus ulcer

Decubitus ulcer (from Latin decumbere — to lie) are areas of ischemic necrosis and ulceration of soft tissues arising from prolonged physical compression, displacement, or friction of the skin between a bony prominence and an external hard surface.

In traumatology, these are the most serious complications for bedridden patients with limb paralysis or severe pelvic fractures.

Etiology and pathophysiology

The main factor is external pressure on soft tissues, exceeding capillary blood pressure. If circulation ceases completely for more than two hours, tissues undergo irreversible oxygen deprivation, cell death, and subsequent necrosis.

Shear force is another crucial mechanism. This occurs when an immobile patient slowly slides down the bed; the superficial skin layers remain in place due to friction while deeper tissues and bones shift, tearing small nourishing vessels. Constant moisture further softens the skin, markedly reducing its barrier functions.

Clinical significance

Clinically, the condition is classified according to the depth of involvement, ranging from superficial skin erythema to deep necrosis with exposure of muscles and bones. For traumatology, this is extremely dangerous as an open wound becomes an entry point for aggressive hospital-acquired infections.

An infected deep pressure ulcer in the sacral area can rapidly lead to purulent destruction of pelvic bones and fatal sepsis. This is why in medicine, prevention of this condition (regular repositioning of the body, anti-decubitus mattresses) is considered significantly more important than subsequent difficult surgical treatment of ulcers.