A sacrum wound, often referred to as a pressure injury or bedsore, represents a common type of skin damage that develops over the sacrum. This triangular bone is located at the base of the spine, just above the tailbone. These wounds occur when sustained pressure on the skin causes localized damage to the tissues.
Understanding the Sacrum and Pressure Injuries
The sacrum is a shield-shaped, triangular bone at the base of the spine, connecting it to the pelvis. Formed by the fusion of five vertebrae, it supports the upper body and transfers weight to the lower limbs, providing stability and protecting organs. A sacrum wound is a type of pressure injury, also known as a pressure ulcer or bedsore. These injuries result from intense or prolonged pressure, or pressure combined with friction or shear forces, typically over bony prominences. The sacrum is particularly susceptible because it bears significant body weight when sitting or lying down. This sustained pressure compresses blood vessels, reducing blood flow and oxygen to soft tissues, which causes damage and cell death.
Causes and Risk Factors
Sacrum wounds primarily develop due to prolonged pressure on the skin, which restricts blood flow to the affected area, leading to tissue damage. Prolonged immobility is a significant factor, as bedridden or wheelchair-bound individuals cannot frequently shift their weight to relieve pressure points. Friction and shear forces also contribute; friction occurs when skin rubs against a surface, while shear involves the skin remaining in place as underlying bone and tissue move, damaging blood vessels.
Moisture, often from incontinence, weakens the skin, making it vulnerable to breakdown and infection. Poor nutrition, including inadequate protein and calorie intake, impairs the body’s ability to maintain healthy skin and heal wounds. Medical conditions like diabetes and circulatory issues can further reduce blood flow and sensation, increasing susceptibility.
Recognizing and Classifying Sacrum Wounds
Recognizing a sacrum wound involves observing changes in the skin over the sacral area, which can range in severity. Pressure injuries are classified into stages based on the extent of tissue damage:
- Stage 1: Involves intact skin with a localized area of non-blanchable redness. This means the skin does not turn white when pressed, and it may appear differently in darkly pigmented skin. The area might also feel warmer, cooler, firmer, or softer than the surrounding tissue.
- Stage 2: Presents as partial-thickness skin loss with exposed dermis. The wound bed is typically pink or red, moist, and may appear as an intact or ruptured serum-filled blister. Adipose (fat) tissue is not visible at this stage.
- Stage 3: Involves full-thickness skin loss where adipose tissue is visible in the ulcer. Granulation tissue and rolled wound edges are often present, and there might be undermining or tunneling.
- Stage 4: Involves full-thickness skin and tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present, and undermining or tunneling often occurs.
- Deep Tissue Pressure Injury (DTPI): Presents as intact or non-intact skin with persistent non-blanchable deep red, maroon, or purple discoloration, indicating damage to underlying soft tissue.
- Unstageable: Refers to full-thickness skin and tissue loss where the extent of the damage cannot be determined because it is obscured by slough or eschar.
Basic Care and Prevention
Basic care for a suspected sacrum wound begins with immediately relieving pressure from the affected area. This involves repositioning the individual, using specialized mattresses, or employing cushions to redistribute weight. Maintaining a clean and dry environment around the wound prevents infection and further skin breakdown. Gentle cleansing with mild soap and water or saline solution may be appropriate. Professional medical evaluation is necessary to assess severity and determine the treatment plan.
Preventing sacrum wounds involves several strategies. Regular repositioning, ideally every two hours for bedridden individuals and more frequently for those in wheelchairs, alleviates prolonged pressure. Good skin hygiene, including keeping the skin clean, dry, and moisturized, maintains skin integrity. Adequate nutrition and hydration support skin health and healing. Utilizing pressure-relieving devices, such as specialized cushions and mattresses, reduces pressure on bony prominences.