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Jonathan Rosenfeld
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March 11, 2021

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Pressure ulcers (also known as bed sores, pressure sores, pressure wounds, or decubitus ulcers) are often the result of localized skin damage when prolonged pressure from an external surface compresses against a bony prominence.

Common areas for bed sores include the back of the head, shoulder blades, shoulders, elbows, tailbone, hipbones, back of the knees, ankles, toes, and most commonly, the heels and sacrum.

areas where pressure ulcers most commonly appear

Source: KCH [1]

Many family members who learn that their loved one has a pressure sore may be unfamiliar with the term and seek more information. Read on to see how this horrific condition manifests and its different stages through bed sore pictures.

Staging Bed Sores

The National Pressure Injury Advisory Panel [2] classifies the stages of pressure ulcers based on the extent of skin and tissue damage in six categories.

Stage 1 Pressure Ulcer Pictures

At its early stage, a bedsore is identifiable by its visibly reddened appearance or a purple/maroon color. Identifying a Stage 1 pressure sore might involve pressing a finger on the affected area to produce non-blanching erythema, where inflammation restricts blood flow.

stage 1 bed sore on back

Stage 2 Pressure Ulcer Pictures

A degrading Stage 1 pressure sore declines to partial-thickness skin loss affecting the epidermis and partial dermis layers. A Stage 2 bedsore is a pink-red shallow open sore with no necrotic (dead) or slough tissue. There may be abrasion and a pus-filled or blood-filled blister.

stage 3 bed sore on tailbone

Stage 3 Pressure Ulcer Pictures

The progressing sore now has full-thickness skin loss involving the epidermis and dermis layers with significant damage or necrosis to subcutaneous tissues. An opening crater extends to the underlying fascia with slough, undermining, and tunneling.

stage 3 bed sore on foot

Stage 4 Pressure Ulcer Pictures

A pressure ulcer’s final stage appears with full-thickness skin loss, substantial destruction, bone damage, and fully exposed necrotic tissue, muscle, tendons, and ligaments.

stage 4 bed sore on tailbone
stage 4 bed sore on buttock
stage 4 bed sore on thigh

Unstageable Pressure Ulcer Pictures

The presence of eschar or slough in the wound bed may hinder a comprehensive assessment from identifying the extent, severity, and size of the pressure sore, making it unstageable.

unstageable bedsore on buttocks
unstageable bed sore on tailbone
unstageable bedsore on foot

Suspected Deep Tissue Injury (SDTI) Pictures

This injury involves maroon red or purple localized discolored intact skin that may include a blood-filled blister caused by soft underlying tissue injury. In its early stages, an SDTI might appear boggy, firm, and extremely painful. The affected area’s temperature might be warmer or cooler than the surrounding area.

suspected deep tissue injury on knee
suspected deep tissue injury on ankle
suspected deep tissue injury on leg

Diagnosing pressure sores and individuals with darker skin can be challenging. Diagnosticians and wound specialists often use other indicators to identify a Stage 1 pressure sore through skin harness, induration, warmth, and discoloration.

Pressure Sore Prevention and Treatment

According to the Centers for Medicare and Medicaid Services [3], nearly every pressure sore is preventable if caregivers follow established protocols when providing skincare treatment, nutrition, and standard health care.

Unfortunately, over 3 million individuals in the United States have bedsores yearly [4]. Negligence is rampant in hospitals and long-term care centers nationwide, and pressure sores are among the most common nursing home abuse injuries.

The elderly (65 years and older), the disabled, and rehabilitating are the most common sufferers. However, many individuals develop pressure sores after surgical procedures for a hip fracture, hip replacement, or spinal cord injury.

The National Institutes of Health [5] recommends the following measures as effective at preventing pressure sores and treating an existing ulcer:

  • Frequently changing position to relieve pressure. People most at risk for developing bed sores should be moved at least once every 2 hours. Those sitting in a wheelchair, chair, or recliner, should have their body weight readjusted at least once every 15 minutes.
  • Keeping the area clean and dry by cleaning the wound using mild soap and warm water (not hot) or saline solution before every dressing change.
  • Applying dressings with microbial properties containing alginic acid (polysaccharide) that promote healing.
  • Applying topical creams to combat the infection, including antibacterial creams that form a barrier protecting vulnerable and damaged skin.
  • Removing necrotic tissue from the open sore to allow better assessment of the wound’s severity using a high-pressure or low-pressure waterjet.
  • Using pressure-relieving devices, including specialized pads, mattresses, and cushions that alleviate, relieve, or spread pressure.
  • Taking necessary antibiotics that treat wound-associated infections of the blood (sepsis), bone (osteomyelitis), or skin.
  • Managing incontinence with incontinence pads, barrier creams, fecal management systems, and cleansers.
  • Improving nutritional intake by adjusting the patient’s daily diet and fluid intake to ensure adequate protein supplementation is available to reduce sores and boost healing.

A wound care specialist or diagnostician may recommend removing dead tissue through surgical procedures. These procedures include surgical debridement and sharp debridement or non-surgical options, including enzymatic debridement that removes necrotic skin from the open sore’s bed, promoting new healthy tissue growth.

Additional bed sore treatments might involve electrical stimulation to promote new tissue growth, VAC (vacuum-assisted) wound closure, and hyperbaric oxygen therapy.

What to Look for and Document About a Deep Tissue Injury

The professional staff at nursing homes and hospitals must conduct a comprehensive head-to-toe skin assessment on patients most at risk for developing decubitus ulcers. Any detected bed sore should be fully documented in the resident’s healthcare plan to ensure they receive the best care for healing.

Documentation identifying a detectable pressure sore should include the following:

  • The sore’s location
  • The stage of the ulcer
  • Pressure ulcers’ size, including its width, depth, and length, measured in centimeters
  • Any identifiable sinus tract, tunneling, or undermining
  • The presence of exudate (oozing fluids), including its location, amount, and color
  • The appearance and size of the wound bed, including a description of visible tissue
  • A description of the sore’s edges, including any evidence of redness, rolled edges, maceration (damaged tissue from prolonged exposure to moisture or water), or induration (localized soft tissue hardening)
  • A description of the area surrounding the sore
  • The absence or presence of pain
  • The absence or presence of any foul odor

Hire A Medical Negligence Lawyer to Resolve Your Bed Sore Injury Compensation Case

Did a caregiver’s negligent actions in a nursing home or hospital lead to your preventable pressure ulcer?

Did you lose a loved one from an avoidable pressure wound in a nursing facility, hospital, or long-term care setting?

Contact our negligence injury lawyers to schedule a free consultation to discuss your legal options. The personal injury attorneys at Rosenfeld Injury Lawyers LLC (888) 424-5757 (toll-free phone number) can help you file and resolve a compensation case.

Our nursing home abuse lawyers accept cases through contingency fee arrangements. This agreement ensures you only pay for our services after we have resolved your compensation case.

The information you and your loved ones share with our law offices remains private and confidential through an attorney-client relationship.

Our law office currently represents injured clients throughout Illinois in Cook County, DuPage County, Lake County, Peoria County, Sangamon County, Will County, Winnebago County, Aurora, Chicago, Joliet, Schaumburg, and Waukegan.

Resources: [1] KCH, [2] NPIAP, [3] CMS, [4] NCOA, [5] NIH

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