What do I need to understand about wounds or pressure injuries after severe brain injury?

Skin health can impact overall health.  A pressure injury means the skin is damaged, because of increased pressure to an area causing a sore or open area of the skin. This can happen very quickly and needs to be monitored daily. After a severe brain injury, a person with DoC cannot move their body to relieve pressure or discomfort from being in one position for a long period of time. Other factors leading to skin pressure injuries include pressure or rubbing from equipment, not moving (“bed sores”), moisture from bladder and bowel incontinence, and surgical incisions not healing properly.

Medical diagram of pressure sores
Stages of pressure sores - iStock medical diagram

Where do wounds or pressure injuries commonly occur?

Immobility is the most common cause of pressure injuries. Pressure injuries, and this can occur early while in the hospital and after a person with severe brain injury has gone home and remains immobile.  Prolonged pressure temporarily cuts off the blood supply to the skin, which causes damage to the cells.  Surgical incisions also can also lead to wounds if they do not heal correctly.  Pressure causing injuries on the bony parts of the body that have little padding of muscle and fat include:

  • Back of the head
  • Spine
  • Tailbone
  • Buttocks
  • Shoulder blades
  • Side of the hips
  • Heels
  • Elbows

How do I keep my loved one’s skin healthy?

It is important to check the skin daily to identify and prevent pressure injuries and to make sure the injury does not worsen. Skin care refers to any technique that improves the healing of skin abrasions, blisters, cracks, infections, lacerations, or ulcers.  Skin care also includes frequent position changes and management of incontinence to decrease the risk of any skin issue.  Skin care begins in the ICU, continues through inpatient rehabilitation, and then. It continues into the home setting with continued support from home-care services. Follow-up can be coordinated with a Wound Care Clinic as needed.
Goals of skin care involves: 

  1. providing good daily hygiene to keep skin clean and dry – head to toe
  2. providing care to the area(s) involved (e.g., cleaning the wound) as directed by the medical team
  3. positioning body parts to avoid pressure and start a turning schedule to prevent new wounds
  4. applying compression bandages
  5. treating swelling or edema
  6. treating infection
  7. improving nutrition and blood-sugar levels to promote healing
  8. using proper fitting equipment, splints/braces, and cushions
  9. improving blood flow and oxygen supply

More detail about skin and pressure injuries: 
Stages of Pressure Ulcers: Stages, Treatments, and More
From Healthline 

The following PDF guides about skin care are from Shepherd Center

Padding and Positioning plan of care:

From Shepherd Center on Vimeo

What do I do if my loved one has wounds or pressure injuries when and if we go home?

For open wounds, it is very important to monitor the wound closely and daily to make sure they do not worsen as pressure injuries can get worse very quickly! First, start with the skin care steps listed above. You will need to stay in contact with your healthcare provider, so they can recommend the best treatment and monitor concerning areas.  Healthcare professionals have training on how to measure the severity and depth of the wound and will develop a treatment plan.

There are also wound-care specialists/nurses who have advanced training to address these issues, so your healthcare provider may consult this type of specialist. The goal is to prevent infection and worsening of the problem that can lead to other medical concerns and/or surgery.