If you are not careful, your skin will give you "color"

Authors: Wu Airong, Xie Haixia, Wei Cuicui, Peng Xuejuan; Chief Judge: Zhai Hua

Unit: Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)

This popular science work is one of the popular science materials in the series "Don't be afraid of spinal cord injuries, there are ways to prevent and rehabilitate them"

My name is "skin". It is the largest organ in the human body. I can protect the body, sweat, feel cold and heat, and pressure, etc. I cover the whole body of a person. My main task is to protect various tissues and organs in the body from physical, mechanical, chemical, and pathogenic microbial invasions. Although my thickness is only 0.5 mm to 4 mm, it is composed of many structures. Please see the picture below to get to know me.

Although I am the largest organ in the human body, I am very powerful and can be regarded as a guardian of human health. But sometimes I am also very fragile and need to be protected, especially when the body is sick, such as in patients with serious diseases such as coma, tumors, paralysis after spinal cord injury, etc. If you are not careful, the skin will show you "color". Next, I will tell you about the damage I may suffer in patients with spinal cord injury.

Because spinal cord injury patients lose normal nerve control below the injury plane, they will experience sensory and motor nerve dysfunction, poor blood circulation in local tissues, and the skin below the injury plane will be slow to respond to or lose sensations of cold, heat, pain, and perception. In this situation, I will be completely unaware of the onset of pressure sores, burns, frostbite, abrasions, incontinence dermatitis, etc. It is very scary. All kinds of injuries will make me, as skin, no longer complete, and even scarred.

Pressure sore : also called pressure injury, refers to localized injury to the skin and/or subcutaneous tissue. Data show that for patients with spinal cord injury, the incidence of pressure sores within one year of injury is 44%, and the incidence of pressure sores in a lifetime will reach 85%. Caused by pressure or pressure combined with shear force, the injury is usually above the bony prominence, or related to equipment and other objects. Different stages of pressure sores have different degrees of damage to me. The lightest is stage 1 and the heaviest is stage 4. Deep tissue damage and non-stageable injuries can easily turn into stage 4 if you don't pay attention.

Burns and frostbite : Spinal cord injury patients are prone to burns or frostbite due to sensory dysfunction in daily life or rehabilitation exercises. For example, using hot water bottles or heat packs in cold weather, or using ice packs to cool down physically when feverish, etc. Or using electrotherapy, phototherapy, heat therapy, moxibustion, etc. during rehabilitation treatment can also become risk factors for burns.

**Abrasions: **Spinal cord injury patients have poor self-protection ability during training, especially when doing transfer movement training, they often drag due to weak upper limb muscle strength or poor grasp of the movement essentials, which can easily cause abrasions on the sacrum and coccyx skin; or when doing sit-ups, excessive force or inappropriate clothing can also cause sacrum and coccyx skin damage.

Incontinence dermatitis : refers to the inflammatory damage of the perineum or perianal skin caused by the skin of patients with spinal cord injury being exposed to urine or feces for a long time. Patients with spinal cord injury and incontinence are more likely to develop incontinence dermatitis. It can cause redness, swelling, eczema, skin ulcers and other degrees of skin damage in the perianal skin.

After reading this, I would like to remind everyone to pay attention to early preventive care. When you have to stay in bed or sit in a wheelchair for a long time, you need to take various preventive measures. One of them is to protect your skin and not let skin damage make your body worse.

What are the specific preventive measures?

Prevention of pressure sores and abrasions

1. Turn patients over every 2 hours, and high-risk patients once an hour. If necessary, develop a decompression turning table to remind caregivers to help patients turn over on time;

2. When lying on your side, use a 20° to 30° tilt position, place a soft pillow between your legs, and use a soft pillow to elevate your heels or a foam pad to protect them;

3. Changes in body position should avoid pressing on bony prominences; avoid placing the patient directly on medical devices (such as tubes, drainage devices, etc.);

4. Patients who sit in a wheelchair for a long time should lift their hips to relieve pressure once every 15 to 30 minutes, each time lasting 1 to 2 minutes;

5. Do not let the patient stay on the bedpan for too long. Use silk fabrics rather than cotton or cotton blends to reduce shear and friction when transferring.

6. Polyurethane foam dressings can be used to prevent bone protrusions that are often subjected to friction and shear forces;

7. Wear appropriate orthotics or lower limb braces according to the patient's functional condition. Choose personalized auxiliary braces with good texture, good flexibility and low friction on the skin, and relax the skin pressure every 2 hours;

8. Develop the habit of regular skin checks (every night, after treatment activities). Patients can use a mirror to self-examine their skin.

Prevention of burns and frostbite

1. When taking a bath or washing your feet, pay attention to the water temperature, which should be close to normal body temperature. Do not soak your feet in hot water;

2. The foot washing time should not be too long, no more than 10 minutes; when washing feet, do not cover the sealed foot washing container with objects;

3. When the weather is cold, do not use hot water bottles or heat pads to keep warm;

4. Do not use the hair dryer on skin that has no feeling or feels poorly;

5. Do not place hot water cups or bowls of hot food on your skin or spill water on your skin;

6. Do not use any heat therapy equipment (such as moxibustion, infrared, etc.) without permission;

7. When using physical cooling methods such as ice packs when having a fever, wrap the ice pack in a towel before use. Do not place it directly on the skin, and the use time should not exceed 30 minutes.

Prevention of incontinence dermatitis

1. Actively deal with incontinence and reduce skin irritation. Use isolation products to prevent the skin from being exposed to excessive moisture, such as isolation cream or film dressings;

2. Scrub and change frequently to keep the skin clean;

3. For patients with urinary incontinence, a urinary catheter should be placed if necessary;

4. For patients with fecal incontinence, feces can be collected using a fecal management collector.

(Some pictures in this article are from the Internet)

References:

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[2] Wang Haiyan, Ma Furong, Li Yunying, et al. Effects of two methods of nursing on the incidence of incontinence dermatitis in patients with spinal cord injury complicated by fecal incontinence[J]. Contemporary Medical Forum, 2020, 18(07): 250-252.

[3] Qian Peijun, Su Juan. Application of OB plug combined with oxygen therapy in preventing skin damage caused by fecal incontinence in patients with acute myelitis[J]. Chinese Modern Doctor, 2021, 59(36): 180-183.

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