Last reviewed: 27 Jun 2021
Last updated: 28 Mar 2018



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

Risk factors

  • immobility
  • sensory impairment
  • older age
  • surgery
  • intensive care stay
  • malnourishment
  • Hx of previous pressure ulcers
  • fecal or urinary incontinence
  • diabetes
  • peripheral vascular disease
  • environmental factors

Diagnostic investigations

Treatment algorithm



Dan R. Berlowitz, MD

Professor of Health Policy and Management

Boston University School of Public Health

Director of the Center for Health Quality, Outcomes, and Economic Research




DRB declares that he has no competing interests.


Dr Dan R. Berlowitz would like to gratefully acknowledge Dr Madhuri Reddy and Dr Stephen Thomas, the previous contributors to this monograph. MR is the author of a number of references cited in this monograph. ST declares that he has no competing interests.

Peer reviewers

Jane Deng, MD

Assistant Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles



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

Cardiff University




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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