Decubitus Ulcer: Understanding Pressure Sores & Causes

Decubitus ulcer (pressure injury, pressure sore, bedsore) is localized damage to skin and/or underlying tissue from sustained pressure, usually over a bony prominence.

Pathophysiology

• Pressure > capillary closing pressure (32 mmHg) → ischemia → necrosis.
• Shear and friction accelerate damage.
• Moisture (incontinence, sweat) macerates skin.

Common Sites

• Sacrum/coccyx (supine)
• Heels (supine)
• Ischial tuberosities (sitting)
• Trochanters (side-lying)
• Occiput, elbows, ears

Staging (NPUAP/EPUAP)

• Stage 1: Non-blanchable erythema of intact skin.
• Stage 2: Partial-thickness skin loss with exposed dermis.
• Stage 3: Full-thickness skin loss.
• Stage 4: Full-thickness skin + tissue loss (muscle/bone exposed).
• Unstageable: Obscured by slough/eschar.
• Deep Tissue Pressure Injury: Persistent non-blanchable deep red/maroon/purple discoloration.

Prevention

• Repositioning q2h (bed), q1h (chair).
• Pressure-redistributing surfaces.
• Skin inspection, moisture management, nutrition optimization.