Muscosal Pressure Ulcers a Risk for Vulnerable Adults
As an attorney who handles nursing home abuse cases, I frequently encounter various forms of avoidable pressure ulcers, including muscosal pressure ulces which are those to the nose, mouth, any other muscous membranes. According to the National Pressure Ulcer Advisory Panel.
Mucosal Pressure Ulcers – An NPUAP Position Statement
Mucous membrane is the moist lining of body cavities that communicate with the exterior. These tissues line the tongue, gastrointestinal (GI) tract, nasal passages, urinary tract and vaginal canal. Pressure applied to this tissue can render it ischemic and lead to ulceration. Mucosal tissues are especially vulnerable to pressure from medical devices, such as oxygen tubing, endotracheal tubes, bite blocks, orogastric and nasogastric tubes, urinary catheters and fecal containment devices.
Definition: Mucosal Pressure Ulcers (MPrU) are pressure ulcers found on mucous membranes with a history of a medical device in use at the location of the ulcer.
Anatomy of Mucous Membrane: Two types of tissue are present in mucous membranes: a nonkeratinized stratified squamous epithelium and an underlying connective tissue layer; the lamina propria. These two layers are analogous to the epidermis and dermis and likewise are connected via rete pegs. There is also a basal laminal layer at the interface of the two tissue layers. The epithelial layer is continuously renewed through migration of lower layers of epithelium to the surface. However, unlike the epithelium of the skin, the epithelium of mucosa is not keratinized. The lamina propria structure varies depending on the location but generally contains blood vessels and elastic and collagen fibers.
Injury to Mucous Membrane: Injury to mucous membrane can occur from direct trauma (burns, bites, pinching, radiation, pressure or infection).
The injured tissue bleeds and forms a clot within minutes. However, because of the moist environment and mucus, the clot does not resemble the hard, dry clots seen on the skin. The clot on mucous membrane is soft and then becomes coagulum, which is easily shed.
More Information About Mucosal Pressure Ulcers
Appearance of Injured Mucous Membrane: Injured mucous membrane responds to injury with inflammation, however due to their underlying color, an inflammatory response may not be visible, but none the less still occurs. Tenderness and edema of injured tissues does occur. Injury that leads to bleeding creates a soft clot (or coagulum) that remains flat and loosely attached to the wounded area. This coagulum is not to be classified as slough, even though both tissues can appear yellow and shiny. Tissue injury to mucous membranes of the mouth can occur from
misfitting dentures and lead to exposed bone, but these ulcers are beyond the scope of this position statement.
Healing Mucosal Pressure Ulcers
Wound healing is the same in mucosa as it is in the skin, except for the formation of scar. There is increasing evidence that fibroblasts in the oral mucosa are phenotypically different from those in the skin and more closely resemble fetal fibroblasts. Scar tissue of the mucosa is remodeled and most injuries heal without scar formation.
For the rest of the article on Mucosal Pressure Ulcers, see Mucosal Pressure Ulcers An NPUAP Position Statement.
This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.
If you or a loved one has suffered an injury from pressure sores or ulcers or any other type of neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member.