Stages of Pressure Ulcer

Introduction

In February 2007, the NPUAP finally released the results of five years of diligent work towards redefining pressure ulcer and its stages. The work began with the recognition of deep tissue injury in 2001. According to the National Pressure Ulcer Advisory Panel, "A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction." There are several other complex contributing factors attached to pressure ulcers, the importance of such factors is yet to be clearly explained.

Stages in Pressure Ulcer

Suspected Deep Tissue Injury:-This is formed as a result of the damage to the soft tissue lying under it, from pressure and/or shear. The result is a maroon or purple colored or discolored skin or the formation of a blister filled with blood on the skin above that tissue. Before such formation, the victim may experience, pain, warmness, coolness, bogginess, firmness or mushiness as compared with the tissue next to it. It is not easy to detect this deep tissue injury if the victim has dark skin complexion. This patch on the skin may eventually evolve into a thin blister. Further, it may evolve into wound and be covered by a thin Eschar. No matter however perfect and severe the treatment, the evolving of the wound will be rapid exposing more and more layers of the tissue, which we call stages of the pressure ulcer…

Stage 1
In the first stage of the ailment, one will notice the intact skin having non-blanchable sore redness of the localized area commonly over a prominently bony area. For victims with dark skin complexion, this may be recognized as that area which is in a different shade of color than the area around it. Yet the initial stage is very difficult to detect with victims having darker skin complexion. The onset of the ailment may sometimes be diagnosed as "at risk" and not confirmed. The affected area may feel firm, warmer or cooler, soft and painful compared to the tissue next to it.

Stage 2
In this stage, the affected area will see a loss of thickness of the skin layer, resulting in an open low lying ulcer with a reddish pink sore area not having slough. Alternately, this stage may also result in a tight or ruptured blister full of serum. Alternately, this stage may see a dry shallow ulcer having no bruising. This step should not be utilized for explaining perineal dermitis, skin tears, excoriation, tape burns or maceration. If in this stage, a wound may be doubted as a deep tissue injury.

Stage 3
This stage will visualize a complete loss of the weight of the tissue. Here subcutaneous fat may be exposed, but one will not see the muscle, tendon or the bone. Slough that is there cannot blur the severity of the tissue lost. This stage may also include tunneling or undermining. The shallowness of the stage 3 pressure ulcer is location-dependent. It is very shallow in the areas where subcutaneous tissue is absent such as nose, occiput, malleolus, ear, etc. Contrastingly, affected areas having excessive fatty tissues will develop very deep stage 3 pressure ulcers. It may not be possible to visualize or touch the underlying bone or tendon.

Stage 4
The final stage here will see a complete loss of the fat under the skin, showing out the bone and muscle. A few areas of the bruise may also see Eschar. Very frequently, this stage involves undermining and tunneling. Again in this stage, the depth of the exposed tissue differs depending on the anatomy of the body. It is very shallow in the areas where subcutaneous tissue is absent such as nose, occiput, malleolus, ear, etc. These final ripened ulcers may evolve further into muscle making osteomyelitis feasible. The bone or tendon showing out can be seen clearly and touched too.