Source: Fish DN, Pendland SL, Danziger
LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee
GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8002378.
Accessed July 22, 2012.
- Decubitus ulcer
- Bed sore
- Pressure sore
- Damage to underlying soft tissue from pressure and/or
- Most pressure ulcers colonized by bacteria; bacteria frequently
infect healthy tissue.
- Cultures reveal polymicrobial growth:
- Aerobic Gram-positive and Gram-negative bacteria
- Factors that predispose to formation of pressure ulcers:
- Advanced age
- Factors critical to formation of pressure ulcers:
- Areas of highest
pressure generated over bony prominences.
- Degree and length of time important.
- Shearing forces
- Exact pathophysiology of pressure ulcer formation unknown.
- Most common among:
- Chronically debilitated
- Spinal cord injury
- Prevention single most important aspect in management
of pressure ulcers.
friction and shearing forces by proper positioning.
- Keep surface relatively free from moisture through skin care
and prevention of soilage.
- Most important factor: pressure relief, even for 5 minutes
once every 2 hours
- Immobilization in bed or wheelchair
- Altered mental status
- >95% of pressure ulcers located on lower part
- Most common areas:
- Sacral and
- Ischial tuberosities
- Greater trochanter
- Great variation in severity, ranging from abrasion to large
lesions that can penetrate into deep fascia involving both bone
- Classification system in Table 1.
Table 1. Pressure Ulcer
Classification |Favorite Table|Download (.pdf)
Table 1. Pressure Ulcer
|Suspected deep tissue injury||Area of discolored intact skin or blood-filled blister due
to damage of underlying soft tissue from pressure and/or
shear. Area may be preceded by tissue that is painful, firm, mushy,
boggy, warmer, or cooler as compared with adjacent tissue.|
|Stage 1||Pressure ulcer generally reversible, limited to epidermis,
and resembles abrasion. Intact skin with nonblanchable redness of localized
area, usually over bony prominence. Area may be painful, firm, soft,
warmer, or cooler as compared with adjacent tissue.|
|Stage 2||Stage 2 ulcer also may be reversible; partial thickness loss
of dermis presenting as shallow open ulcer with red pink wound bed.
May also present as intact or open/ruptured serum-filled blister
or as shiny or dry shallow ulcer.|
|Stage 3a||Full-thickness tissue loss. Subcutaneous fat may be visible,
but bone, tendon, or muscles not exposed. May include undermining
and tunneling. Depth of ulcer varies by anatomical location; may
range from shallow to extremely deep over areas of significant adiposity.|
|Stage 4a||Full-thickness tissue loss with exposed bone, tendon, or
muscle; can extend into muscle and/or supporting structures
(e.g., fascia, tendon, or joint capsule), making osteomyelitis possible. Often
includes undermining and tunneling; depth of ulcer varies by anatomical
|Unstageablea||Full-thickness tissue loss in which base of ulcer covered
by slough (yellow, tan, gray, green, or brown) and/or eschar
(tan, brown, or black) in wound bed. True depth, and therefore stage, cannot