Types of Chronic Wounds  Pressure Ulcers
Pressure ulcers are also known as decubitus ulcers or bedsores. Every person with limited mobility, regardless of age, is at risk for developing a pressure ulcer. It typically occurs over bony areas in bed- or chair-bound individuals. While pressure ulcers can occur anywhere on the body, they are most often located in the tailbone (sacral), hip (trochanteric), buttocks (ischial), or heel of the foot.
Prevention & Staging
The most important component of care for pressure ulcers is a close daily examination of the body, especially focusing on the:
- Buttocks
- Heels
- Sacrum (tailbone)
- Hips
If a break in the skin is noted, treatment must be initiated immediately. Daily assessments should note any change in:
- Drainage
- Redness
- Odor
- Low-grade fever
Pressure ulcers are generally classified according to the degree of tissue damage involved. The following is based on the National Pressure Ulcer Advisory Panel staging definitions:
 |
| Stage I |
- The skin is intact, but the top layer (epidermis) is red in color. When pressure is relieved, the coloration is pink, red, or mottled.
- For persons with darker pigmentation, the ulcer may appear as a defined area with persistent red, blue, or purple hues.
- The site may be associated with warmness/coolness, edema (swollen due to fluid), or hardness.
|
| Stage II |
- A breakage in the skin occurs, including the top layer of the skin (epidermis) and/or the layer under the epidermis (dermis).
- The skin is broken, cracked, blistered, and mottled in color. It may look like a shallow crater, an abrasion, or blister.
- The ulcer remains superficial.
|
| Stage III |
- Full damage to the skin and tissue under the skin that may extend down to, but not through, underlying fascia.
- The ulcer may present itself as a deep crater. Undermining or tunneling may be present. Undermining or tunneling occurs when the ulcer continues past the wound edge under the skin.
|
| Stage IV |
- Extensive damage to or death (necrosis) of subcutaneous tissue, muscle, bone, joints, tendons, or any supporting structures.
- The ulcer may include undermining. (See Stage III for a definition of undermining.)
- It is important to emphasize that a Stage IV ulcer extends anywhere past the fascia, but does not have to involve the bone. When the bone is involved it is most serious.
|
Eschar or necrotic tissue is dead tissue that should be debrided immediately. The eschar/necrotic tissue creates an environment were bacteria can grow.
|
