4 Stages of Pressure Ulcers and Bedsores Explained

Pressure ulcers, commonly known as bedsores, are a significant health concern, particularly for individuals who are immobile or bedridden. Understanding the 4 stages of pressure ulcers can help in early identification and treatment, thereby reducing the risk of severe complications. 

In this comprehensive guide, we will:

• Explain how pressure ulcers form
• Explain who is most at risk
• Detail the 4 stages of bedsores 
• Discuss treatment options and advancements in wound care for treating the 4 stages of pressure ulcers

What Are Pressure Ulcers and How Do They Form?

Pressure ulcers are injuries to the skin and underlying tissue primarily caused by prolonged pressure on the skin. They often develop on skin that covers bony areas of the body, such as heels, ankles, hips, and the tailbone. The constant pressure against the skin reduces blood flow to the area, which can lead to tissue damage and necrosis. 

Pressure ulcers can also form due to shear and friction. Shear occurs when two surfaces move in opposite directions, such as when a bed-bound person slides down in bed. Friction happens when the skin is dragged across a surface, like bedding or clothing. Both shear and friction can damage the skin and underlying tissue, contributing to the development of pressure ulcers. 

Who Is Most Susceptible To Pressure Ulcers?

 Certain groups of people are more susceptible to developing pressure ulcers, including: 

• Individuals with limited mobility: Those who are bedridden, use a wheelchair, or have difficulty changing positions. 
• Elderly people: Aging skin is more fragile and less elastic, making it more prone to damage.
• Patients with certain medical conditions: Conditions that affect blood flow, such as diabetes and vascular disease, increase the risk of bedsores.
• Malnourished individuals: Poor nutrition can impair skin health and healing.
• People with spinal cord injuries: Lack of sensation and mobility increases the risk of pressure ulcers. 

What Are the 4 Stages of Pressure Ulcers?

Understanding the 4 stages of bedsores is crucial for early intervention and effective treatment. 

Stage 1: Non-Blanchable Erythema of Intact Skin

In stage 1, the skin is intact but shows signs of redness (erythema) that does not blanch (turn white) when pressured. This stage indicates the beginning of tissue damage. Symptoms may include pain, warmth, or a firmer or softer area compared to surrounding tissue. The skin may also appear differently in darker skin tones, showing discoloration instead of redness. 

Stage 2: Partial-Thickness Skin Loss With Exposed Dermis

Stage 2 pressure ulcers involve partial-thickness skin loss with exposed dermis. The ulcer is a shallow open wound with a pink or red wound bed, or it may appear as an intact or ruptured blister. The damage extends through the epidermis and into dermis, but does not affect deeper tissues. This stage may be painful and more susceptible to infection. 

Stage 3: Full-Thickness Skin Loss

At stage 3, the damage extends through the dermis into the subcutaneous (fatty) tissue. The wound may have a crater-like appearance and can include undermining and tunneling, where the wound extends under the surrounding intact skin. The risk of infection increases, and the wound may produce exudate (fluid) and slough (yellow or white tissue). 

Stage 4: Full-Thickness Skin and Tissue Loss

Stage 4 pressure ulcers are the most severe, involving both skin and underlying tissue loss. The damage extends into the muscle, tendon, ligament, or even bone. These deep wounds may have a large amount of necrotic tissue (eschar) and extensive undermining or tunneling. Stage 4 bedsores are extremely painful and carry a high risk of serious infection, including osteomyelitis (bone infection) and sepsis (blood poisoning). 

How Are Pressure Ulcers Treated?

Effective treatment of pressure ulcers depends on the stage and severity of the wound. Here are general guidelines for treating each stage:

Treatment of Stages 1 and 2:

• Relieve pressure: Use specialized mattresses (also called offloading or pressure redistribution mattresses), cushions, or pads to reduce pressure on affected areas.
• Clean and moisturize: Keep the skin clean and well-moisturized. Use mild soap and water or saline solution for cleansing.
• Dressings: Apply appropriate dressings to protect the wound and promote healing. Hydrocolloid or foam dressings are commonly used. 
• Monitor and assess: Regularly inspect the skin for signs of improvement or worsening.

Treatment of Stages 3 and 4:

It’s especially important to seek treatment by a qualified team of wound care health professionals when pressure ulcers reach stages 3 and 4. They may employ the following treatment therapies, or a combination of several:

• Debridement: Remove necrotic tissue to promote healing. This can be done through surgical, enzymatic, or autolytic (a moist environment using the body’s own enzymes) methods.
• Advanced dressings: Use advanced wound dressings such as alginates or hydrogels to manage exudate and encourage healing. 
• Infection control: Administer antibiotics if there is an infection. Maintain strict hygiene to prevent contamination. 
• Nutrition: Ensure adequate nutrition, including protein, vitamins, and minerals to support wound healing.
• Surgery: In severe cases, surgical intervention may be necessary to remove damaged tissue from the wound. 

What Are the Latest Advancements in Wound Care for Stage 4 Pressure Ulcers?

Recent advancements in wound care have significantly improved the management and treatment of stage 4 pressure ulcers. Some of the latest innovations include:

Negative Pressure Wound Therapy (NWPT)

NPWT involves applying a vacuum dressing to the wound, which reduces pressure, removes exudate, and promotes tissue granulation. This method has shown effectiveness in accelerating the healing process and reducing infection risk. 

Growth Factors and Bioengineered Skin Substitutes

Growth factors such as platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF) can stimulate cell growth and tissue repair. Bioengineered skin substitutes, made from natural or synthetic materials, provide a scaffold for new tissue growth and help close the wound. 

Biological Skin Graft Therapy

Biological grafts, such as amnion grafts, are able to jump-start healing in even the most challenging chronic wounds. These types of grafts have incredible natural healing properties.

Advanced Dressings

Innovative dressings, such as antimicrobial dressings with silver or honey, help reduce bacterial load and promote a healthy wound environment. Foam dressings with silicone adhesive borders provide better adherence and minimize skin damage during dressing changes. 

Electrical Stimulation 

Electrical Stimulation uses low-level electrical currents to stimulate cell growth and enhance blood flow to the wound. This therapy has shown potential in promoting faster healing of chronic wounds. 

Specialized Understanding of Pressure Ulcers Is Critical for Early Identification and Effective Treatment.

At HealPrecisely™, we employ many of these therapies and more to achieve some of the highest healing rates in the wound care industry.* These include amnion grafts, 3D grafts, and Cellular, Acellular and Matrix-Like Products (CAMPs). We also use the most advanced diagnostic tools in wound care today, such as the Near Infra-Red Spectroscopy (NIRS), which evaluates tissue oxygen saturation in the wound and fluorescence imaging, which provides real-time information on the bacterial load in the wound.

Perhaps the best innovation we bring to wound care is our Mobile Care Clinic, which brings the latest wound care advancements directly to the patient’s bedside, whether that’s at home or in an assisted living facility. 

*Comparison of 1096 clinics/341,742 wound events. Wound Expert EHR by NEThealth. In direct comparison with these clinics, HealPrecisely™ healed 98.05% of patients, with the national average at 82.47% – a difference of 5.58%. The national average days to healing is 62, with HealPrecisely™ healing in an average of 30 days – a difference of 32 days, a 52% quicker healing rate.