Pressure Ulcer Health Article

Definition

Pressure ulcers, also commonly known as bedsores, decubitus ulcers, and pressure sores, are among the most serious skin injuries. These tender or inflamed patches develop when skin covering a weight-bearing part of the body is squeezed between bone and another body part or some other hard object. The ulceration results from the loss of blood flow and oxygen (ischemic hypoxia) to the tissues owing to prolonged pressure on a body part.

Description

Pressure ulcers are most likely to occur in people who have decreased mobility, including the frail, elderly, or seriously ill. People who have atherosclerosis (artery disease), diabetes, heart disease, incontinence, malnutrition, obesity, paralysis, and spinal cord injuries are all at high risk for developing pressure ulcers. This often-painful condition usually begins with shiny red skin that quickly blisters and deteriorates into open sores that can harbor life-threatening infections. These ulcerations are most likely to develop on the:

• ankles
• back of the head
• heels
• hips
• knees
• spine
• shoulder blades

Pressure ulcers usually develop over bony prominences and are graded, or staged, to classify the amount of tissue damage that is observed. These stages are:

• Stage I. The skin is reddened, and the damage may be superficial. The first sign of skin ulceration occurs when pressure squeezes the tiny blood vessels that supply the skin with nutrients and oxygen. The area does not return to its normal appearance after the source of pressure is removed.
• Stage II. There is partial-thickness skin loss involving the epidermis (outer layer), the dermis (inner layer), or both. The skin is blistered, peeling, or has a shallow crater, though the damage is still minor.
• Stage III. There is full-thickness skin loss involving damage to, or necrosis (death) of, the subcutaneous (under the skin) tissue. It may extend down to, but not through, the underlying fascia (connective tissue). This type of ulcer usually appears as a deeper crater. Drainage may be seen.
• Stage IV. Full-thickness skin loss is present, with extensive tissue destruction and damage to muscle, bone, or the supporting structures such as tendons. This stage of ulceration is associated with high morbidity.