Pressure Ulcers
Localised damage to skin and underlying tissue, usually over a bony prominence, caused by sustained pressure or pressure combined with shear; early recognition and pressure relief are the core interventions.
Definition
A pressure ulcer is localised injury to skin and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure or pressure combined with shear. In UK practice, use a validated categorisation system and document unstageable or deep tissue injury when the depth or pattern cannot yet be fully determined.
First principles
Pressure and shear injure tissue before the surface looks dramatic
When tissue is compressed between a bony prominence and a support surface, perfusion falls; sustained loading can cause ischaemia and necrosis. Shear from sliding, friction and moisture-related maceration reduce tissue tolerance and can produce deep injury beneath intact or only subtly discoloured skin. This is why the sacrum, heels, hips, ischial tuberosities, elbows and occiput need deliberate inspection.
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