Classification and Stages of Pressure Ulcers or Bedsores

Pressure ulcers are skin lesions that can be classified based on the damage they cause. They typically occur when soft tissue is pressed against bone, causing damage to the epidermis.

Of the four stages , symptoms can range from mild skin redness to severe tissue damage. Sometimes, depending on the depth of the scar, infections develop, which can spread to muscle and bone.

Pressure ulcers are classified into four stages. It's very useful to know the stages or degrees of development when we have a bedridden family member, so you know how to treat each one.

The 4 stages of pressure ulcers

The first signs of bedsores begin with the appearance of a purple undertone on the skin. The problem can progress very quickly, causing blisters or even necrosis in the soft tissue. It's important to know where you are on the classification to avoid major problems in muscles, bones, or tendons. Let's look at the existing levels of the scale:

Stage I

In the first degree, we can observe a change in pressure related to the intact skin . There are some indicators compared to the adjacent or opposite area of ​​the body that may include changes in one or more of the following: skin temperature (warmth or coldness), tissue consistency (firm or soft), and sensation (pain, itching).

The first signs of a scar appear when a defined area of ​​persistent redness (erythema) appears on the skin that doesn't blanch when pressed. In people with darker skin, scars may appear red, blue, or purple.

Prevention at this stage : At this stage, it's best to protect the area and ensure it's constantly moist. It's also a good idea to use special anti-bedsore cushions and mattresses that help distribute pressure evenly.

Stage II

This stage shows a partial loss of skin thickness , involving the epidermis and/or dermis. We don't yet see slough (dead tissue), but we do see a pinkish and reddish undertone, indicating the presence of a wound.

The ulcer is superficial and presents clinically as an abrasion. We will notice the presence of blisters (filled with serum) or shallow craters.

Prevention: It's best to apply dressings to keep the ulcer moist. Position the patient differently to avoid pressure on the area and protect the damaged skin.

Stage III

At this stage, there is a complete loss of skin thickness . No part of the tendon or bone will ever be visible, as only the fatty tissue, known as subcutaneous tissue, is affected. The wound clinically presents as a deep crater.

How to improve at this stage: It's very important to remove dead tissue and facilitate the drainage of humoral fluid. Protect the cavity very well.

Stage IV

A more advanced stage, where the thickness of the skin and tissues has been completely lost. The eschar extends to the point of necrosis and the appearance of muscles, bones, and/or tendons. Damage to supporting structures such as the fascia or joint capsule also becomes visible. Infections may occur.
Advice: Use antibiotics and consult a doctor to check the condition of the bone, tendon, or muscle.

Important in stages 3 and 4

In these stages, there may be little or no pain due to significant tissue damage. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can occur if pressure ulcers progress.

Unclassified stages of bedsores

In some cases, a deep bedsore is suspected but cannot be confirmed or classified. When there is no open wound, but the tissues beneath the surface have been damaged, the sore is called a deep tissue injury (DTI). The skin area may appear purple or dark red, or there may be a blood-filled blister.

If you or your doctor suspect a pressure ulcer, the area is treated as a pressure ulcer as a preventative measure. You can find out a person's risk of developing pressure ulcers using the Norton scale.

There are also pressure sores that are "unstable," meaning the classification is unclear. In these cases, the base of the sore is covered by a thick layer of other tissue and pus that may be yellow, gray, green, brown, or black. The doctor cannot see the base of the pressure ulcer and determine the classification.

This article is for informational purposes only. If you have any questions, please consult a healthcare professional.