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Pressure Ulcers

Pressure Ulcers (Bedsores)

Pressure ulcers, also called bedsores, are injuries to skin and underlying tissues that result from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks.

People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for prolonged periods. Bedsores can develop quickly and are often difficult to treat. Several care strategies can help prevent some bedsores and promote healing.

Bedsores fall into one of four stages based on their severity.

Stage I

The beginning stage of a pressure sore has the following characteristics:

  • The skin is intact.
  • The skin appears red on people with lighter skin color, and the skin doesn't briefly lighten (blanch) when touched.
  • On people with darker skin, there may be no change in the color of the skin, and the skin doesn't blanch when touched. Or the skin may appear ashen, bluish or purple.
  • The site may be painful, firm, soft, warmer or cooler compared with the surrounding skin.

Stage II

The stage II ulcer is an open wound:

  • The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
  • The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
  • It may also appear as an intact or ruptured fluid-filled blister.

Stage III

At this stage, the ulcer is a deep wound:

  • The loss of skin usually exposes some amount of fat.
  • The ulcer has a crater-like appearance.
  • The bottom of the wound may have some yellowish dead tissue (slough).
  • The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV

A stage IV ulcer exhibits large-scale loss of tissue:

  • The wound may expose muscle, bone and tendons.
  • The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
  • The damage often extends beyond the primary wound below layers of healthy skin.

Common sites of pressure sores

For people who use a wheelchair, pressure sores often occur on skin over the following sites:

  • Tailbone or buttocks
  • Shoulder blades and spine
  • Backs of arms and legs where they rest against the chair

For people who are confined to a bed, common sites include the following:

  • Back or sides of the head
  • Rim of the ears
  • Shoulders or shoulder blades
  • Hip, lower back or tailbone
  • Heels, ankles and skin behind the knees