Pressure ulcers are a common problem in hospital inpatients and people who live in care facilities.
Older people, and all patients with limited mobility or impaired sensation, are at increased risk.
Pressure damage usually occurs over bony prominences but can develop on any part of the body subjected to sustained localized pressure.
Pressure damage varies from small superficial lesions to extensive wounds with bony involvement that contain a mass of necrotic tissue.
Prevention is better than cure; all patients at risk of sustaining pressure damage should be assessed and provided with appropriate pressure-reducing strategies. Using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers.
Management of pressure ulcers is determined by the location and condition or severity of the wound. Wounds should be managed in accordance with wound care practices or policies.
A pressure ulcer is defined as localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device.
It can present as intact skin or an open ulcer and occurs as a result of intense and/or prolonged pressure, or pressure in combination with shear. Pressure ulcers most commonly occur over bony prominences but can develop on any part of the body, including mucosal surfaces. They may be small, superficial wounds or blisters involving only epidermal elements or extensive, deep wounds, covered or filled with necrotic tissue and involving fascia, muscle, and bone.
The term pressure injury is increasingly preferred to pressure ulcer in the US.
History and exam
Key diagnostic factors
- use of nonpressure-relieving support surface
- localized skin changes on areas subjected to pressure
- shallow open wound or tissue loss on areas subjected to pressure
- a full-thickness wound on areas subjected to pressure with or without undermining (tunneling)
- a full-thickness wound with involvement of major tissues on areas subjected to pressure with or without undermining (tunneling)
- localized tenderness and warmth around area of wound
- increased exudate and/or foul odor
- sensory impairment
- older age
- intensive care stay
- history of previous pressure ulcers
- environmental factors
- fecal or urinary incontinence
- peripheral vascular disease
1st investigations to order
- clinical diagnosis
Investigations to consider
- wound swab
- serum glucose
- deep tissue biopsy
Dan R. Berlowitz, MD
Professor; Department of Public Health
University of Massachusetts-Lowell
DRB declares that he has no competing interests. DRB is the author of a number of references cited in this topic.
Dr Dan R. Berlowitz would like to gratefully acknowledge Dr Madhuri Reddy and Dr Stephen Thomas, the previous contributors to this topic.
MR is the author of a number of references cited in this topic. ST declares that he has no competing interests.
Jane Deng, MD
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
JD declares that she has no competing interests.
Keith Harding, FRCGP, FRCP, FRCS
Sub Dean of Innovation & Engagement
Head of Section of Wound Healing
School of Medicine
KH has worked in the area of wound healing for many years and has helped establish and sustain a section of wound healing in a university medical school. The school is entirely self-funded and receives funding from a wide range of commercial concerns in addition to the NHS and grant-giving bodies. The funding is provided to the University rather than to KH personally, and this funding is used to provide sustainability for a wide range of individuals employed within this section.
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