Pressure sores involves all layers of skin and presence of septicemia and fatal one is called:
What are pressure ulcers?
Pressure ulcers are also known as bedsores and decubitus ulcers. They range from closed to open wounds and are classified into a series of four stages based on how deep the wound is:
- Stage 1 ulcers have not yet broken through the skin.
- Stage 2 ulcers have a break in the top two layers of skin.
- Stage 3 ulcers affect the top two layers of skin, as well as fatty tissue.
- Stage 4 ulcers are deep wounds that may impact muscle, tendons, ligaments, and bone.
- Bedsores occur most often after a person sits or lies in one position for too long. The immobility cuts off blood circulation to specific parts of your body, damaging surrounding tissues.
Pressure ulcers form mainly on any skin that covers bony areas of the body. Common places for bedsores to develop include:
- butt
- tailbone
- heels
- ankles
- hips
- back
- elbows
- shoulder blades
- back of the head
Two kinds of more severe pressure ulcers do not fit into one of the four stages:
- suspected deep pressure injury
- unstageable sores
Stages of pressure ulcers and treatment
Pressure ulcers can progress in four stages based on the level of tissue damage. These stages help doctors determine the best course of treatment for a speedy recovery.If caught very early and treated properly, these sores can heal in a matter of days. If left untreated, severe bedsores may require years to heal.
Stage 1
The first stage is the mildest and affects the upper layer of your skin. In this stage, the wound has not yet opened.
Symptoms
The affected area has no surface breaks or tears but may:
- appear red in people with lighter skin and blue or purple in people with darker skin
- remain red or darker for more than 30 minutes after pressure is removed
- not turn pale if pressed firmly
- be sore to touch
- have a warmer temperature from the surrounding normal tissues
- feel firmer than surrounding tissues
- cause mild burning or itching
Treatment
The first step to treating a stage 1 bedsore is to remove pressure from the area. Any added or excess pressure can cause the ulcer to break through the skin surface. If you’re lying down, adjust your position or use pillows and blankets as extra padding.
It’s also important to keep the affected area clean and dry to reduce tissue damage.
Stay well hydrated, and add foods high in calcium, protein, and iron to your diet. These foods help with skin health.
Recovery
If treated early, developing stage 1 pressure ulcers can heal in about 3 days.
Stage 2
In the second stage, the sore area of your skin has broken through the top layer of skin (epidermis) and some of the layer below (dermis). The break typically creates a shallow, open wound.
Symptoms
A stage 2 bedsore may appear as:
- a shallow, crater-like wound, or
- a serum-filled (clear to yellowish fluid) blister that may or may not have burst
It may also cause the following symptoms:
- some drainage or pus at the ulcer
- pain
- swollen, sore, or red tissue around the sore, which indicates tissue death or damage
Treatment
Similar to treating stage 1 pressure ulcers, you should treat stage 2 sores by removing pressure from the wound. You must seek medical attention for proper treatment.
Your doctor will advise you on specialized wound dressings to keep this area dry and clean. This helps prevent the wound from becoming more severe or infected.
Once you’ve cleaned the ulcer, talk with your doctor about how to bandage it properly. It’s also important to monitor the wound for any signs of infection, including:
- worsening pain
- pus
- red skin
- fever
Recovery
Healing from this stage can last anywhere from 3 days to 3 weeks.
Stage 3
Sores that have progressed to the third stage have broken completely through the top two layers of the skin and into the fatty tissue below.
Symptoms
An ulcer in this stage may resemble a hole or crater. You’ll likely notice visible fat tissue but should not be able to see muscle or bone.
In this stage, it’s important to look for signs of infection. These include:
- foul odor
- pus
- redness
- discolored drainage
Treatment
You must seek immediate medical treatment if you have a stage 3 pressure ulcer. These sores need special attention.
Your doctor may prescribe antibiotic therapy and remove any dead tissue to promote healing and to prevent or treat the infection.
If you’re immobilized, your doctor may recommend a special mattress or bed to relieve pressure from the affected areas.
Recovery
Ulcers in this stage usually need at least 1 to 4 months to heal.
Stage 4
Stage 4 pressure ulcers are the most serious. These sores extend below the subcutaneous fat into your deep tissues, including muscle, tendons, and ligaments. In more severe cases, they can extend as far down as the cartilage or bone.
There’s a high risk of infection at this stage.
Symptoms
You may notice the following symptoms in a stage 4 bedsore:
- extreme pain
- drainage
- dead tissue, which may appear black
- visible muscles and sometimes bone
- common signs of infection, like a foul smell and pus
- a dark, hard substance known as eschar (hardened dead wound tissue)
Treatment
People with stage 4 pressure ulcers need to be taken to the hospital immediately. Your doctor will likely recommend surgery.
Recovery
Recovery for this ulcer can take anywhere from 3 months to 2 years to completely heal.
Additional types
In addition to the four main stages of pressure ulcer formation, there are two other categories: unstageable pressure ulcers and suspected deep tissue injury.
Unstageable pressure ulcers are also hard to diagnose because the bottom of the sore is covered by:
slough: debris that appears tan, yellow, green, or brown in color
eschar: hard plaque that’s tan, brown, or black in color
Your doctor can only determine how deep the wound is after clearing it out. If there’s extensive tissue damage, it will need to be surgically removed.
In certain areas of the body, dry and stable covering shouldn’t be touched. This dry eschar is the body’s natural layer of protection.
Stages
Decubitus ulcers occur in stages. There’s a staging process to help your healthcare professional diagnose and treat you.
Stage 1 and 2 ulcers usually do not require surgery, but stage 3 and 4 ulcers may.
Stage 1
The skin isn’t broken, but it’s discolored. The area may appear red if you have a light complexion. The discoloration may vary from blue to purple if you have a darker complexion.
For example, if you have a lighter complexion, a sore can turn red instead of turning lighter when you press on it. The sore will stay red for at least 30 minutes.
It may also:
- feel warm to the touch
- look swollen
- be painful
- itch
- burn
Stage 2
A break in the skin reveals a shallow sore or cut that may leak pus. The sore may also look like a blister filled with fluid. It affects the first (epidermis) and possibly the second (dermis) layers of skin.
The ulcer hurts, and the surrounding skin may be discolored.
Stage 3
The ulcer is much deeper within the skin, affecting your fat layer. You should not be able to see bones or tendons.
The sore looks like a crater and may be foul smelling.
Stage 4
This ulcer is very deep and affects many tissue layers, possibly including the bone. There is a lot of dead tissue and pus. Infection is likely in this stage.
You may be able to see:
- muscle
- bones
- tendons
- joints
Unstageable
Sometimes, it’s not possible to measure the depth of a sore or the amount of tissue damage that has occurred. This makes it difficult to fully evaluate and stage an ulcer.
This may be due to the presence of a hard plaque called an eschar inside the sore. The sore may look:
- tan
- brown
- black
Ulcers can also contain discolored debris known as slough that may appear:
- yellow
- tan
- green
- brown
Your doctor may need to remove the eschar or slough to determine the full extent of the ulcer. Further imaging or surgical evaluation of the area may be required.
