Decubitus ulcers are injuries to the skin and soft tissue that occur when prolonged pressure obstructs blood flow. Decubitus ulcer staging helps doctors determine the best treatment plan for these types of wounds.
Also known as bedsores, pressure ulcers, or pressure sores, decubitus ulcers affect people living with medical conditions, such as paraplegia or quadriplegia, that restrict their mobility.
Spending extended periods seated or lying down without changing position leads to obstructed circulation that can cause pressure ulcers.
This article reviews decubitus ulcer staging, complications, recovery, and outlook.
Doctors consider several factors when evaluating pressure ulcers, including:
- tissue condition and color in and surrounding the wound
- whether the wound is leaking fluid, as well as the amount, and type
- signs of infection
- the condition of the wound’s edges
- wound depth, length, and width
- the presence of tunneling or undermining, where there is a larger wound area than is visible at the surface
The type of wound tissue is also important. Doctors look for:
- granulation, or new connective tissue that fills the wound
- epithelial, or new growth of surface skin
- fibrinous, or clots
- eschar, or dead tissue that has dried or cornified
- slough, or dead tissue that is wet or liquified
Decubitus ulcer staging involves assessing how many layers of skin and tissue exhibit changes or damage.
Staging helps doctors determine appropriate treatment, as well as offering an estimation of the wound healing time.
- Stage 1: The ulcer has intact skin and discolored areas that do not turn white when pressed.
- Stage 2: The ulcer has partial skin damage that may include blisters.
- Stage 3: The ulcer has full-thickness skin loss with subcutaneous tissue visible.
- Stage 4: The ulcer exposes deeper subcutaneous tissue and possibly bones, tendons, muscles, or vital organs.
- Unstageable: The ulcer has full-thickness skin loss covered by slough or eschar.
- Deep tissue injury: The ulcer has intact skin covering an unknown amount of tissue damage underneath.
Learn more about the treatment and prevention of bed sores here.
The ulcer’s stage impacts recovery time. Depending on the stage of the pressure ulcer, staging can take anywhere from days to months.
A 2015 study of 270 people averaging 83.9 years of age found that stage 2 pressure ulcers took about 23 days to achieve re-epithelialization, which is the formation of a new top layer of skin.
The study found that ulcers smaller than 3.1 square centimeters (cm2) healed faster, with a median time of 19.2 days. Ulcers 3.1 cm2 or larger took a median of 31 days.
A 2018 study found that the following factors contributed to successful wound healing:
- higher hemoglobin and mean arterial pressure
- oral nutrition
- better mobility
- discharge from hospital
Pressure ulcers can lead to several serious complications, including:
Infection is a primary complication of decubitus ulcers and can cause issues, such as:
- cellulitis, a bacterial infection affecting deeper layers of skin, soft tissues, and fat beneath
- abscesses, when body tissue becomes inflamed and fills with pus
- osteomyelitis, which is the infection and inflammation of the bone
- bacteremia, which is when bacteria are in the blood
A 2018 study that evaluated bacteremia associated with pressure ulcers (BAPU) found that the bacteremia had several sources:
- 35.7% were hospital-acquired
- 26.8% were healthcare-related
- 37.5% were community-acquired
Around 25% of the infections were polymicrobial, which means they were the result of several microorganisms.
A pressure ulcer can become a malignancy called a Marjolin’s ulcer. When this happens, the cancer is usually squamous cell carcinoma.
It can be difficult to tell the difference between a pressure ulcer and a Marjolin’s ulcer without a tissue biopsy, which experts consider a reliable method of diagnosis.
Gangrene is tissue death that results from infection, lack of blood flow, or both.
Gangrene is a serious condition that requires prompt medical care.
Treatment includes the removal of the affected tissue, including amputation, when necessary. Doctors can prescribe antibiotics if bacteria are involved.
Pressure ulcers use a large amount of energy, which can cause malnutrition. They may cause:
Untreated pressure ulcers can result in dangerous complications, such as infection, cancer, and gangrene. However, treatment can make a difference.
The pressure ulcer healing rate after 6 months of treatment is:
- greater than 70% for stage 2
- 50% for stage 3
- 30% for stage 4
Early stage pressure ulcers can heal when treatment is timely and appropriate. More severe wounds can heal with continued treatment.
Decubitus ulcers are also known as bed sores or pressure ulcers. They are the result of prolonged pressure that cuts off circulation and results in tissue damage.
Doctors stage pressure ulcers according to severity. Staging helps doctors determine the most effective treatment plan for each wound.
Potential complications include infection, cancer, gangrene, and malnutrition. Prompt treatment in the early stages reduces the chance of complications.