23/05/2026
Pressure Ulcer / Pressure Injury: Localised damage to the skin and underlying soft tissue caused by prolonged pressure, often combined with shear, friction, or moisture, usually over bony prominences. It is common in immobile or critically ill patients, and management focuses on pressure offloading, wound care, infection control, nutrition, and prevention of recurrence.
🔹 Core risk factors
➟ Immobility or bed-bound state
➟ Reduced sensation
➟ Poor nutrition
➟ Incontinence or excess moisture.
🔹 High-risk patients
➟ Elderly patients
➟ Spinal cord injury
➟ Stroke or paralysis
➟ ICU, postoperative, or long-term care patients.
🔹 Local pressure sites
➟ Sacrum
➟ Heels
➟ Hips / greater trochanter
➟ Ischial tuberosities, elbows, ankles, occiput may also be involved.
🔹 Early sign
➟ Non-blanchable erythema
➟ Skin remains red after pressure is relieved
➟ May feel warm, firm, painful, or boggy
➟ In darker skin, look for color change, warmth, edema, or firmness.
🔹 Skin breakdown signs
➟ Blistering
➟ Shallow open ulcer
➟ Partial-thickness skin loss
➟ May appear as an abrasion-like or serum-filled blister lesion.
🔹 Deep ulcer signs
➟ Full-thickness skin loss
➟ Visible subcutaneous fat may be seen
➟ Muscle, tendon, or bone may be exposed in severe disease
➟ Undermining or tunneling may occur.
🔹 Infection clues
➟ Increasing pain
➟ Purulent discharge
➟ Foul odor
➟ Surrounding erythema, warmth, fever, or cellulitis.
🔹 Risk assessment
➟ Examine skin regularly in at-risk patients
➟ Use structured risk tools such as the Braden Scale
➟ Assess mobility, moisture, nutrition, sensation, and perfusion
➟ Document wound size, depth, stage, exudate, odor, and surrounding skin.
🔹 Initial management
➟ Relieve pressure immediately
➟ Reposition regularly
➟ Use pressure-redistributing mattress, cushions, or heel protectors
➟ Avoid direct pressure on the ulcer.
🔹 Wound care
➟ Clean with normal saline or appropriate wound cleanser
➟ Maintain a moist wound-healing environment
➟ Use dressing based on exudate level and wound depth
➟ Debride necrotic tissue when appropriate.
🔹 Infection management
➟ Do not use systemic antibiotics for colonization alone
➟ Use antibiotics if cellulitis, sepsis, osteomyelitis, or spreading infection is present
➟ Culture deep tissue or aspirate if infection is suspected
➟ Evaluate for osteomyelitis in deep ulcers over bone.
🔹 Nutrition and systemic care
➟ Optimize protein and calorie intake
➟ Correct dehydration
➟ Treat anemia, diabetes, vascular disease, and edema
➟ Nutrition deficiency increases risk and delays healing.
🔹 Prevention
➟ Frequent repositioning
➟ Daily skin inspection
➟ Keep skin clean and dry
➟ Manage incontinence and reduce friction/shear.
🔹 Advanced management
➟ Negative-pressure wound therapy may help selected deep wounds
➟ Surgical flap closure may be needed for large stage 3 or stage 4 ulcers
➟ Multidisciplinary care improves outcomes
➟ Treat the cause, not just the wound.
🔹 High-Yield Points
➟ Pressure ulcer = pressure injury over bony prominence
➟ Major risks: immobility, moisture, malnutrition, poor perfusion, reduced sensation
➟ Earliest sign: non-blanchable erythema
➟ Management = offloading + repositioning + wound care + nutrition + infection control
➟ Prevention is the most important strategy.
Medical disclaimer: This note is for education only and is not a substitute for professional medical advice, diagnosis, or treatment.
