What Are Pressure Ulcers?

What Are Pressure Ulcers?

Pressure ulcers, also known as bedsores or pressure sores, are injuries to the skin and underlying tissue primarily caused by prolonged pressure on the skin. They typically develop on skin that covers bony areas of the body, such as the heels, ankles, hips, and tailbone. People most at risk of pressure ulcers are those with a medical condition that limits their ability to change positions or causes them to spend most of their time in a bed or chair.

Understanding Pressure Ulcers

Pressure ulcers can develop quickly and are often difficult to treat. They are categorized into four stages, based on their severity, with Stage I being the mildest and Stage IV being the most severe. These wounds can lead to serious infections, cause significant discomfort, and impact the quality of life.

Causes and Risk Factors

The primary cause of pressure ulcers is prolonged pressure against the skin that limits blood flow to the skin and nearby tissues. Other factors that can contribute to the formation of pressure ulcers include:

  • Friction: Rubbing or dragging the skin against a surface can make fragile skin more vulnerable to injury, especially if the skin is moist.
  • Shear: Movement in which layers of skin slide against each other, such as when a bed-bound person is improperly pulled up in bed, can cause shearing and damage to skin and tissue.
  • Immobility: People who are bedridden, use a wheelchair, or are unable to change their position are at higher risk of developing pressure ulcers.

Certain individuals are at a higher risk, including those with a spinal cord injury, neurological disorders, poor nutrition, decreased mental awareness, and conditions affecting blood flow.

Symptoms and Identification

Pressure ulcers are identifiable by their location and stage. The common signs include:

  • Stage I: Reddened, unbroken skin that does not blanch (lighten) when pressed.
  • Stage II: Loss of skin thickness, presenting as a blister, abrasion, or shallow crater.
  • Stage III: Full-thickness skin loss potentially exposing fat, with the ulcer appearing as a deeper crater.
  • Stage IV: Full-thickness skin and tissue loss, with muscle, bone, or tendon visible.


  • Complications of pressure ulcers can be severe, including:
  • Infection: This can lead to cellulitis, bone and joint infections, or systemic infections (sepsis).
  • Chronic Wounds: Some pressure ulcers can become chronic wounds, which are difficult to heal and can lead to significant tissue damage.
  • Cancer: Long-term, non-healing wounds can increase the risk of developing a type of squamous cell carcinoma.

Prevention Strategies

Prevention is key in managing pressure ulcers, including:

  • Frequent Repositioning: Changing positions frequently to alleviate pressure on vulnerable areas.
  • Skin Care: Keeping the skin clean and dry to prevent infection and deterioration.
  • Proper Nutrition: A diet rich in protein, vitamins, and minerals to promote skin health and healing.
  • Use of Support Surfaces: Specialized mattresses and cushions that distribute weight more evenly.

Treatment Approaches

  • Treatment of pressure ulcers involves both general and specific interventions:
  • Reducing Pressure: Using support surfaces and repositioning to relieve pressure.
  • Cleaning and Dressing Wounds: Keeping the ulcer clean and dressed with appropriate materials.
  • Removing Damaged Tissue (Debridement): Removing dead or infected tissue to promote healing.
  • Controlling Infection: Using antibiotics if there is evidence of infection.

Wound Care Treatment

Effective wound care is critical in the treatment of pressure ulcers. This includes:

  • Regular Cleaning: Gently clean the ulcer with a saline solution to remove loose, dead tissue.
  • Appropriate Dressings: Use dressings like hydrocolloid or foam dressings that maintain a moist healing environment and cushion the wound.
  • Negative Pressure Wound Therapy (NPWT): Applying suction to the wound to increase blood flow and promote healing.
  • Surgical Intervention: In severe cases, surgery might be necessary to clean the wound or close it with a flap of healthy skin.

Regular assessment by healthcare professionals and following a comprehensive treatment plan are vital in managing and healing pressure ulcers.

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