Pressure injuries

A pressure injury on the skin is caused by constant pressure to that area. The pressure damages the skin and underlying tissues, creating an injury. This can happen when you lie in bed or sit in a wheelchair for a long time.

Pressure injuries usually occur over bony areas, such as your sit bones, hips, lower back, elbows, heels, and shoulders. Pressure injuries can also occur in places where the skin folds over on itself, or where medical equipment presses on the skin, such as when oxygen tubes press on the ears or cheeks.

Pressure injuries can range from red areas on the surface of the skin to severe tissue damage that goes deep into muscle and bone. Severe injuries are hard to treat and slow to heal. When pressure injuries do not heal properly, problems such as bone, blood, and skin infections can develop.

At first, the skin may appear reddened. Or the skin may look purple or dark red. In darker skin, the color may differ from that of nearby skin. The injury may be tender and warm to the touch. It may break open or form an ulcer where fat, bone, or muscle may be visible.

A doctor can diagnose a pressure injury by examining it. In some cases, the doctor may want to do blood tests to check for infection or to see if you're getting enough protein in your diet. The doctor may also want to do a skin and wound culture or a skin biopsy.

Treatment focuses on preventing a pressure injury from getting worse and on making the skin healthy again. It may include:

• Taking pressure off the area, changing positions often, and spreading body weight evenly with special mattresses, pads, or other support.
• Keeping the wound clean and covered with a bandage. The doctor will tell you how to care for your wound. You may need to keep the wound a little moist and not let it dry out between bandage changes.
• Eating a healthy diet with enough protein.
• Having debridement. This is when the doctor removes dead tissue from the wound to promote healing.
• Having surgery. Severe pressure injuries may be treated with surgery. A tissue flap or skin graft may be needed.

Negative-pressure wound therapy, also called vacuum-assisted closure, may be used to help with healing.

Researchers continue to study these and other treatments for wounds, including electrical stimulation, hyperbaric oxygen therapy, platelet-derived growth factor, and ultrasound therapy.

• Change positions often. For example, change positions about every 2 hours when lying down and every 15 to 30 minutes while sitting. Try setting a timer to remind yourself.
• If your doctor prescribed a medicated ointment or cream, use it exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Wash pressure injuries every day, or as often as your doctor recommends. Most tap water is safe, but follow the advice of your doctor or nurse. They may recommend that you use a saline solution. This is a salt and water solution that you can buy over the counter.
• Put on bandages as your doctor or wound care specialist says.
• Keep healthy tissue around the sore clean and dry.
• Check your skin every day for sores (or have a caregiver do it).
• If you know what caused the injury, find a way to remove that pressure.