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DermatologicalICD-10: L89.90Affects approximately 2.5 million patients annually in the U.S.; prevalence in long-term care facilities is 10-18%

Pressure Ulcers (Bedsores)

Pressure ulcers, commonly known as bedsores or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin, typically over bony prominences such as the heels, hips, tailbone, and shoulder blades. They most often develop in people with limited mobility—those who are bedridden, use a wheelchair, or are unable to change positions independently. Pressure ulcers are a significant healthcare problem, associated with increased morbidity, mortality, and healthcare costs.

Symptoms

Unusual changes in skin color or texture (redness that does not blanch with pressure)
Swelling, warmth, or tenderness in the affected area
An area of skin that feels softer or firmer than surrounding tissue
Open wound or blister exposing deeper layers of skin
Crater-like ulcer in advanced stages (Stage III-IV)
Foul-smelling drainage from the wound
Exposed muscle, bone, or tendon in severe (Stage IV) ulcers

Causes

  • Sustained pressure on skin reducing blood flow to the tissue
  • Friction when skin rubs against bedding, clothing, or wheelchair surfaces
  • Shear forces when the body slides down in a bed or chair, distorting blood vessels
  • Moisture from sweat, urine, or feces softening and weakening the skin (maceration)

Risk Factors

  • Immobility from paralysis, coma, or post-surgical recovery
  • Advanced age with thinner, more fragile skin
  • Poor nutrition and dehydration impairing tissue healing
  • Urinary or fecal incontinence causing persistent skin moisture
  • Decreased sensation from spinal cord injury, neuropathy, or diabetes
  • Poor circulation from vascular disease or heart failure

Diagnosis

  • Visual inspection and staging of the wound (Stage I through IV, plus unstageable)
  • Assessment using validated risk tools (Braden Scale) for prevention
  • Wound culture if infection is suspected
  • Blood tests including albumin, prealbumin, and complete blood count to assess nutrition and infection

Treatment

  • Pressure relief through frequent repositioning (every 2 hours in bed, every 15-30 minutes in a wheelchair)
  • Specialized pressure-redistribution mattresses and cushions
  • Wound care including debridement of dead tissue and appropriate dressings
  • Negative pressure wound therapy (wound VAC) for deeper ulcers
  • Nutritional optimization with adequate protein, calories, and hydration
  • Antibiotics for infected pressure ulcers
  • Surgical flap closure for large, non-healing Stage III-IV ulcers

Prevention

  • Reposition bedridden patients every 2 hours and wheelchair users every 15-30 minutes
  • Use pressure-redistributing mattresses, overlays, and cushions
  • Keep skin clean, dry, and moisturized
  • Ensure adequate nutrition with sufficient protein and caloric intake
  • Perform regular skin inspections, especially over bony prominences
  • Manage incontinence promptly to prevent skin maceration

When to See a Doctor

  • You notice any persistent area of redness or skin breakdown over a bony area
  • An existing pressure ulcer shows signs of infection (increased redness, warmth, swelling, pus, or odor)
  • A wound is not showing signs of healing despite appropriate care

Frequently Asked Questions

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

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