What is a pressure ulcer?

A decubitus ulcer is also known as a pressure ulcer or bedsore. It is damage to the skin and underlying tissue caused by prolonged pressure on a specific part of the body. A pressure ulcer is caused by pressure on the skin and tissue that impairs blood circulation to the affected area. This results in an insufficient supply of nutrients and oxygen to the body's cells. This can cause the tissue to die and an ulcer to form.

Pressure sores can occur on almost any part of the body, but are most common in areas where the bones are close to the surface of the skin, such as the heels, hips, ankles, tailbone or shoulder blades.

People who have to spend long periods of time in bed or wheelchairs are particularly at risk, as they are exposed to increased pressure on certain parts of the body.

In addition to TIME and PRESSURE, fundamental factors in the development of pressure sores are so-called shear forces.

Shear forces occur when different tissue layers are displaced in opposite directions on top of each other, or next to each other. That is, when one part of the skin is shifted in one direction and another in the opposite direction. These shear forces can easily occur, for example, when sliding in a chair or bed.

Pressure ulcers are divided into categories depending on their severity. These range from category 1. which has a slight reddening of the skin, to category 4. which reaches deep down to the bone. Treatment depends on the severity of the pressure ulcer and can range from simple measures, such as pressure relief and wound care, to surgical intervention. It is important to recognise a pressure ulcer as early as possible and to initiate appropriate measures to prevent progression and further complications.

How are the 4 categories of pressure ulcers defined?

The 4 categories of pressure ulcer are defined based on the severity of skin and tissue damage. Here are the categories in detail:

Category 1: A Category 1 pressure ulcer is mild damage to the skin caused by prolonged pressure or friction. The skin is red and may be tender, but there are no signs of an open wound yet.

Category 2: A category 2 pressure ulcer is damage to the skin and underlying tissue. It usually shows an open wound that may look like a crater. But blistering is also possible, where the upper layer of skin is still closed, but deeper layers of skin are already affected. The wound is usually painful and may become infected.

Category 3: A category 3 pressure ulcer is a deep injury that affects all layers of the skin and underlying tissue. The wound looks like a deep hole and the surrounding tissue may die. There is a high risk of infection and complications.

Category 4: A category 4 pressure ulcer is the most severe form and affects all layers of the skin, subcutaneous fat, muscle and bone. The wound is very deep and may extend to the bone. There is a high risk of infection, blood poisoning and life-threatening complications.

It is important to recognise a pressure ulcer early and treat it before it gets worse. Careful skin monitoring and appropriate measures such as regular repositioning and pressure relief can help reduce the risk of pressure ulcers and their complications.