Where are pressure sores most likely to occur?

In daily life, pressure sores are also called bedsores. They are generally a symptom caused by local necrosis of the skin of the body. Long-term bed rest or limited mobility can easily lead to pressure sores on the body. Pressure sores can easily lead to wound infection or cause fever. The common sites of pressure sores are generally human joints, elbows, ribs, etc.

Where are pressure sores most likely to occur?

1. Prone areas

It often occurs on bony protrusions that are not covered by muscles or have a thin muscle layer, lack the protection of fat tissue and are often under pressure.

(1) In the supine position, the disease is most common in the occipital protuberance, scapula, elbows, vertebral protuberance, sacrum, and heels.

(2) The disease is most common in the side-lying position, including the ears, acromion, elbows, ribs, hips, medial and lateral sides of the knee joints, and medial and lateral malleolus.

(3) Prone position is more common on the ears, cheeks, shoulders, female breasts, male genitals, iliac crest, knees, and toes.

2. Clinical staging

(1) Suspected deep tissue injury: The subcutaneous soft tissue is damaged by pressure or shear force. The local skin is intact but may change color such as purple or brown-red, or cause congested blisters. The soft tissue in these damaged areas may be painful, hard, have a sticky discharge, be moist, warm, or cool compared to the surrounding tissue.

(2) The first stage of pressure ulcers is the congestion and ruddy stage - "redness, swelling, heat, pain or numbness that lasts for 30 minutes and does not fade". The skin over the bony prominence is intact and accompanied by localized erythema that does not fade when pressed. Dark skin may not show obvious paleness, but may be a different color than the surrounding tissue.

(3) The second stage of inflammatory infiltration of pressure sores - "purple, hardened, painful, and blistered", with partial loss of the dermis, appearing as a shallow open ulcer with a pink wound bed (wound surface) and no slough. It may also appear as a complete or ruptured serological blister.

(4) The third stage of pressure ulcers is shallow ulcer stage - the epidermis is damaged and ulcers are formed. Typical features: full-thickness skin tissue is missing, subcutaneous fat is exposed, but bones, tendons, and muscles are not exposed. There is slough, but the depth of tissue loss is unclear and may include undermining and tunneling.

(5) Stage IV: Necrotic ulcer stage - invasion of the subdermis, muscle layer, bone surface, and spread of infection. Typical features: full-thickness tissue loss with exposed bone, tendon, or muscle, slough or eschar in some parts of the wound bed, and often undermining or tunneling.

(6) Typical features of unstageable pressure ulcers: full-thickness tissue loss, slough covering the ulcer base (yellow, tan, gray, green, or brown), or eschar attached to the wound bed (charcoal, brown, or black).

Pressure ulcer prone areas

Pressure ulcers often occur on bony protrusions that are frequently under pressure and have no muscle coverage or a thin muscle layer and lack of fat tissue protection. The predilection site of the disease varies depending on the patient's lying position.

1. Supine position, such as the occipital protuberance, shoulder blades, elbows, sacrum, heels, etc., most commonly occurring in the sacrum.

2. Side-lying position such as the auricle, acromion, ribs, hips, inner and outer sides of the knee joints, inner and outer ankles, etc.

3. Prone position such as cheeks, auricle, acromion, anterior superior iliac spine, costal protrusions, anterior knees, toes, etc.