Pressure · shear · off-loading · reconstruction
Pressure Injuries
Pressure injuries form when sustained pressure or pressure combined with shear exceeds the tissue’s ability to tolerate the load. Healing requires more than dressing the open area; the mechanical cause must be removed.
01
Why pressure injuries occur
Pressure injuries are common over bony prominences and under medical devices. Immobility, impaired sensation, frailty, moisture, poor nutrition and reduced perfusion can increase risk. Deep tissue damage can exist before the surface fully declares the extent of injury.
02
Evaluation
Assessment includes location, stage/depth, undermining, tunneling, devitalized tissue, drainage, surrounding skin, infection, bone exposure, nutrition, mobility, support surface, positioning and the patient’s ability to maintain pressure relief.
Rapid progression, systemic illness, impaired circulation, severe infection or threatened deep structures should not wait for a routine outpatient visit.
03
Treatment framework
Treatment can involve pressure redistribution, repositioning, support surfaces, moisture control, nutrition optimization, debridement, local wound care, treatment of infection when present and management of spasticity or contractures that perpetuate pressure.
04
When reconstruction is considered
Large stage 3 or stage 4 wounds, exposed bone, recurrent breakdown or wounds that cannot close with local care may require plastic-surgical reconstruction. Durable flap coverage generally depends on controlling the pressure source and optimizing the patient enough to protect the reconstruction afterward.
Common questions
Questions about pressure injuries
These are general educational answers. Diagnosis and treatment require direct clinical assessment.
Is a pressure injury the same as a bedsore?
“Bedsore” is an older informal term. Pressure injury is broader and includes wounds caused by pressure and shear in beds, chairs, wheelchairs, footwear and medical devices.
Can pressure injuries occur even with good nursing care?
Yes. Risk can remain high in patients with immobility, critical illness, poor perfusion, severe frailty or inability to tolerate repositioning. Prevention focuses on reducing modifiable risk as much as possible.
Do all pressure injuries need debridement?
No. Debridement depends on tissue type, perfusion, infection, location and overall goals of care. Some stable dry eschar, particularly in poorly perfused areas, may require a different approach.
When is surgery used?
Surgery may be considered for selected deep or recurrent wounds when underlying causes can be controlled and durable soft-tissue coverage is needed.
How important is nutrition?
Nutrition is one of several important contributors to wound repair. Assessment of calorie, protein and micronutrient needs may be appropriate, particularly in frail or malnourished patients.
