Pressure Sores

Reference Pressure sores Opens New Window usually develop on the skin over a Reference bony area Opens New Window Reference Opens New Window where there is less cushion between the skin and bones. Most pressure sores develop on the lower part of the body, on the skin over the Reference sacrum Opens New Window and tailbone (the lowest part of the back), the hips, buttocks, or heels. Pressure sores also occur on the back of the head, the backs of ears, around the shoulders and elbows, between the knees, and over the ankles.

Pressure sores are described in four Reference stages Opens New Window Reference Opens New Window:^{Reference 1}

• Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears Reference reddened Opens New Window Reference Opens New Window and does not blanch (lose color briefly when you press your finger on it then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it.
• At stage 2, the skin usually breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion) or a shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die.
• During stage 3, the sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone.
• At stage 4, the pressure sore is very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, Reference tendons Opens New Window, and Reference joints Opens New Window may occur.

In stages 3 and 4 there may be little or no pain due to significant tissue damage. Serious Reference complications, such as infection of the bone (Reference osteomyelitis Opens New Window) or blood (Reference sepsis), can occur if pressure sores progress.

Sometimes a pressure sore does not fit into one of these stages.

• In some cases, a deep pressure sore is suspected but can't be confirmed. When there isn't an open wound but the tissues beneath the surface have been damaged, the sore is called a deep tissue injury (DTI). The area of skin may look purple or dark red, or have a blood-filled blister. If you or your doctor suspects a pressure sore, the area is treated as though a pressure sore has formed.
• There are also pressure sores that are "unstageable," meaning that the stage is not clear. In these cases, the base of the sore is covered by a thick layer of other tissue and pus that may be yellow, gray, green, brown, or black. The doctor cannot see the base of the sore to determine the stage.

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