Pressure ulcers
Pressure ulcers (pressure injuries) are localized areas of skin and soft-tissue damage over a bony prominence, most often the sacrum, ischium, heel, or trochanter, caused by unrelieved pressure, friction, moisture, and shear in an immobilized patient. Management begins with immediate pressure redistribution and repositioning at least every 2 to 3 hours, paired with wound-bed debridement, moisture-balanced dressings, and culture-directed antibiotics reserved for spreading cellulitis, sepsis, abscess, or confirmed osteomyelitis rather than colonization.
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What this article covers
- Overview
Definition: a pressure ulcer (pressure injury) is localized damage to the skin and underlying soft tissue, usually over a bony prominence, resulting from unrelieved pressure or from pressure combined with shear.
- Epidemiology
Older adults in hospital or long-term care are most commonly affected and experience serious morbidity from pressure ulcers.
- Risk factors
Immobility: bed-bound or wheelchair-bound status, including patients in the intensive care unit or long-term nursing facility.
- Pathophysiology
Four converging mechanical forces: vertical pressure, friction, moisture, and shearing forces acting over a bony prominence in an immobilized patient combine to damage skin and soft tissue.
- Clinical features
Establishing features by stage define the clinical picture and drive the treatment plan: stage 1 is intact skin with persistent nonblanchable erythema or color change, possibly with associated edema…
- Differential diagnosis
Arterial ulcer: a sharply demarcated, punched-out wound with little to no granulation tissue, a dry, pale, or necrotic base, and cool, shiny surrounding skin, distinguished from a pressure ulcer by…
- Diagnosis
The diagnostic basis is clinical staging using the National Pressure Ulcer Advisory Panel system: location over a bony prominence in an immobilized patient, together with the depth and tissue…
- Management
First, immediately relieve pressure over the wound: reposition the patient using an individualized plan, commonly at least every 2 to 3 hours for a bedbound at-risk patient on an appropriate…
- Complications
Osteomyelitis, confirmed by bone histology and culture, particularly for pelvic pressure ulcers.
- Prognosis
Most injuries present early and are potentially reversible: stage 1 and stage 2 together make up roughly 90% of cases, while stage 3 and stage 4 combined make up about 10%.
- Prevention
Reposition bed-bound patients at a minimum interval of every 2 hours, using an individualized plan that may be more frequent for at-risk patients.
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