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A pressure injury is a lesion that develops on the skin and underlying tissues, usually over bony areas. It is due to unrelieved pressure in combination with shear.
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Pressure injuries result from lying or sitting in one position for too long a time, with or without with a shear force. The skin and tissues need enough blood supply for oxygen and nutrients. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to become damaged and dies.
Several factors contribute to the development of pressure injuries including:
This condition is more common in older adults and people of African American or Hispanic descent. Other factors that may increase the chances of pressure injuries:
Symptoms of a pressure injury may include:
You will be asked about your symptoms and medical history. A physical exam will be done. Pressure injuries are staged according to the depth and tissues that are involved.
Your bodily fluids may be tested. This can be done with:
Imaging tests may be done with:
Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure injuries. In many cases, a caregiver will provide care for your pressure injuries.
Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as advised.
You or your caregiver will be taught how to tend to the wound. Some basic instructions include:
You may need to take pain medication a 30-60 minutes before dressing changes.
Eat a well-balanced meal. Your doctor may recommend vitamins, minerals, or supplements.
The doctor may surgically remove dead tissue. Skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.
Phototherapy using ultraviolet light may have some benefits when used in combination with other treatments. In some, it has been shown to reduce healing time.
Most pressure injuries can be prevented by being aware of the risk. To help reduce the chances of pressure injuries:
Family Doctor—American Academy of Family Physicians
National Pressure Ulcer Advisory Panel
The College of Family Physicians of Canada
Pressure ulcer. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116231/Pressure-ulcer. Updated October 27, 2017. Accessed March 13, 2018.
Pressure ulcer staging illustrations. National Pressure Ulcer Advisory Panel website. Available at: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations. Accessed March 13, 2018.
Taking care of pressure sores. University of Washington Medicine website. Available at: sci.washington.edu/info/pamphlets/pressure_sores.asp. Updated March 13, 2018.
5/27/2011 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T116231/Pressure-ulcer: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4):CD001735.
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6/22/2015 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T116231/Pressure-ulcer: Qaseem A, Mir TP, Starkey M, et al. Clinical Guidelines of the American College of Physicians. Risk assessment and prevention of pressure ulcers; a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):359-369.
Last reviewed March 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD Last Updated: 3/13/2018