4 Different Stages Of Bedsores You Need To Understand

Bedsores are skin lesions that develop as a result of unrelieved pressure forces or pressure forces mixed with shearing forces over a short period of time, enough to interfere with the blood supply in the affected area.

The sores could go from the superficial to the deeper layers of the skin, occurring most of the time over boney protuberances. Bedsores are also called pressure injuries, decubitus ulcers, or pressure sores.

Patients with gait impairment secondary to any physical or memory problems are at potential risk for developing bedsores. This medical problem is most of the time missed in patients in all settings – outpatient, in-patient, and long-term care facilities.

Additional risk factors may include poor general health status, poor nutrition, urinary and fecal incontinence, poor hygiene, low socioeconomic status, and advanced age.

Some of the most common pathologies associated with bedsores are cerebrovascular disease sequelae affecting mobility and mentation, moderate to severe dementia of all cases, severe rheumatoid arthritis, amputation in general, spinal cord injury, and frailty.

Multifactorial interventions to reduce and prevent the development of pressure ulcers are among the top strategies currently recommended to be implemented in different settings.

Different Stages of Bedsores

# Stage I: Persistent redness

At this stage, the affected skin is still intact, usually over a bony area. The skin of darkly pigmented individuals may not appear pale, but its color may be different from the surrounding affected area if a lesion is present.

The area, in general, may be painful, firm, and soft with a different temperature from that of the adjacent skin.

# Stage II: Partial-thickness skin or tissue loss

At this stage, the skin could be open as a superficial ulcer without associated tissue death.

The lesion could also appear as an intact or ruptured blister. It could be shiny or dry and shallow or superficial without bruising or tissue death. At this level, the affected area most likely is painful and tender.

# Stage III: Full-thickness skin loss

Full-thickness skin loss is when the lesion has deepened into the subcutaneous fat without exposing bones, tendons, or muscles.

Dead tissue may be associated without hiding the depth of skin loss. Other complications including skin erosion and tunneling may be present.

The depth of the sore varies by the area of the body affected. Some examples could be the ear, lower back of the head, bridge of the nose, and distal portion of the legs where there is no fatty subcutaneous tissue.

The ulcers can be superficial, contrasting with areas of significant adiposity where the sore could be extremely deep.

# Stage IV: Full-thickness tissue loss

Stage IV bedsores could look like an extensive wound with possible muscle, tendon, and bone exposure with or without associated dead tissue (slough or eschar) and localized discharge.

The depth of the ulcer varies by anatomic location as explained with the stage III lesion, but the difference is stage IV ulcers can extend into muscles and supporting structures such as the tendon, joint capsule, and fascia.

At this stage, infection of the bone, known as osteomyelitis, is likely to occur. The muscle and exposed bone could be visible and/or directly palpable.