Bedsores are areas of skin that become inflamed and open up under excess pressure being applied to the skin. Under conditions of moisture, shear forces and friction, delicate skin is overwhelmed by the pressure and the circulation decreases in the affected body area.
Pressure sores happen usually to areas that have bony prominences, such as the heels, ankles, elbows, tailbone and knees.
There are four stages of bedsores that differ in their severity. These include the following (1):
Stage 1 of a bedsore is when the skin is mildly irritated and red, but does not have open wounds. There are no breaks in the skin and the only symptoms are pain and redness. The redness doesn’t blanch, meaning that it doesn’t whiten when you push your finger on the reddened area.
In people with darker skin tones, the bedsore may appear discolored and different from the normal skin surrounding it, but it is rarely red in color. The temperature of the skin in stage 1 disease is warmer than the normal skin. The connective tissue of the skin can feel softer or firmer than the normal skin that surrounds it. These can be treated by keeping pressure off of them and by cleansing them with mild soap and water, patting the skin dry so that it doesn’t stay too moist.
During stage 2 of this disease, the skin wears away and breaks open. An ulcer is formed in the affected area that is usually painful and tender to the touch. It can extend into the deep layers of the skin and usually resembles a blister or a shallow crater on the skin.
Bedsores in stage 2 can actually form a blister that becomes fluid filled with clear fluid. Some of the skin in stage 2 of this disease is irretrievably lost and dies away. It is usually treated by soaking the wound in saline (salt water) and be debriding the dead tissue away so that he ulcer can heal itself. It often takes several weeks for a stage 2 ulcer to heel to the point where the skin is no longer broken.
Stage 3 involves a deeper sore than stage 2 and it usually extends into the deeper layers beneath the broken skin. A small, visible crater is formed that may have dead or fatty tissue in it. While it is deep, it does not show evidence of having bone or tendon involvement.
The dead tissue needs to be debrided using a variety of techniques, including surgery. The wound is then dressed to protect it from getting infection. Stage 3 bedsores are difficult to treat, especially if pressure is not relieved from the affected area.
Stage 4 is the most severe type of a bedsore. The sore is extremely deep and muscle, bone and other connective tissue is affected. There can be damage to tendons that does not heal and there is usually a lot of dead tissue within the wound. The dead tissue must be debrided, usually with surgery, so that the remaining viable tissue can heal.
There needs to be dressings applied to these wounds and they cannot be exposed to any type of pressure so that the sore can heal fully. This stage of bedsores are very prone to infection and extremely difficult to treat. Many of the patients with stage 4 disease are malnourished and generally do not heal well.
People who have stage 3 and stage 4 disease may not feel any type of pain because the pain fibers of the skin have been diminished. The biggest risk with these stages of bed ores is infection. The infection can become so severe that it infects the bone, a condition called osteomyelitis. Sepsis, or blood infections, can occur in stage 3 and stage 4 of the disease if the sores are not treated aggressively.
Sometimes, a bedsore doesn’t fit neatly into a category or stage. The pressure sore can be deep but its’ full depth cannot be identified. The skin may be intact, but there is death to the tissues deep to the skin. This is known as a deep tissue injury (DTI) and is extremely difficult to treat. However, the risk of infection is less because the skin is not open.
These unstageable pressure sores may look like a blister filled with blood. Even though the skin is intact, the doctor will treat the area as though it is an actual bedsore. The area should be kept clean and dry and pressure should be taken off the area so the body has a chance to allow the bedsore to heal.
The unstageable bedsores are named as such because the actual stage of the lesion is not completely clear. In such cases, the bottom of the sore can be covered by a thickened layer of connective tissue along with pus that may be black, brown, gray, green or yellow. In this type of bedsore, the doctor will be unable to see the bottom of the sore to decide what stage the sore is in.