What it is
A pressure injury is damage to skin and the tissue beneath it, usually over a bony area such as the tailbone, hips, heels or shoulder blades. It is typically caused by pressure, or by pressure combined with friction or shearing, that reduces blood flow to the area over time. People who have limited mobility, who spend long periods in a bed or chair, or who have reduced sensation may be more at risk.
Clinicians commonly describe pressure injuries in stages, from Stage 1 through Stage 4. Stage 1 generally refers to intact skin with persistent redness that does not fade when pressed. Stage 2 involves partial loss of the skin's top layers, such as a shallow open area or blister. Stage 3 involves full-thickness skin loss, where fat may be visible. Stage 4 involves deeper loss that may reach muscle, tendon, ligament or bone.
There are also categories that do not fit neatly into numbered stages. An unstageable injury is one where the base of the wound is covered, for example by dead tissue, so its depth cannot be seen. A deep tissue pressure injury shows deep, persistent discoloration of intact or broken skin and can sometimes look milder than it is. Only a trained clinician can assign a stage, and a wound's stage can be re-assessed as it changes.
How it’s traditionally been approached
Traditionally, care for pressure injuries has centered on relieving pressure on the affected area, since pressure is the underlying cause. Clinicians have long used repositioning schedules, specialized mattresses and cushions, and attention to skin checks, moisture and nutrition as part of overall care. What is appropriate varies from person to person.
For open wounds, approaches have commonly included cleaning the wound, removing non-viable tissue (known as debridement), and choosing dressings meant to support a suitable healing environment. Clinicians also assess for signs of infection and look at other factors that affect healing, such as circulation, blood sugar management and general health.
For more complex or slow-to-heal wounds, specialists may consider additional options, such as negative pressure wound therapy, which is well established. Skin substitutes and amniotic or placental grafts vary in regulatory status; most are regulated as minimally manipulated tissue rather than as FDA-approved drugs, and coverage differs by product and payer. Hyperbaric oxygen therapy has FDA-cleared indications in certain situations, but whether any of these options fits a particular wound is a decision for a licensed clinician after an evaluation. For further reading specifically on amniotic products, amnioticdoctors.com is one resource, and it is not affiliated with WoundKare.
How the right wound care specialist may help
The right wound care specialist may help by examining the wound, identifying its likely cause, and describing its stage and any complicating factors. A visit generally includes a review of your health history, medications and daily routines, a look at the wound and surrounding skin, and a conversation about what the findings may mean. The specialist may also look at the person's bed, chair, and positioning, and involve caregivers in the discussion.
Specialists may coordinate with other professionals, such as nurses, dietitians, physical or occupational therapists, and physicians, since healing often depends on more than the wound itself. Whether a given approach is appropriate is something a licensed clinician decides after an evaluation, and no outcome can be promised.
It can help to bring questions to the visit. Consider asking: What is the cause of this wound? What stage is it, and could that change? What are my treatment options, and what are the pros and cons of each? What is the expected healing time? What signs should prompt me to call you or seek care right away? What will my insurance likely cover, including any advanced products or therapies?
The whole-person view
Body, mind and stress affect each other, and that is true with wounds too. Pain, disrupted sleep, reduced mobility and the demands of ongoing care can wear on mood and energy, while stress and low mood can in turn affect appetite, rest and daily routines. Looking at the whole person, not only the wound, is a thoughtful way to approach care.
Some people find body-based support helpful for reconnecting with their physical sense of safety and comfort, and Somatic Experiences is one place to learn about that approach. Others value talking through the emotional weight of a long recovery, and Therapists.plus can help you explore talk therapy options. These are complements to, not replacements for, medical wound care.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Only a licensed professional can diagnose and stage a pressure injury, so please have any suspected bed sore evaluated rather than relying on this page.
- Seek medical care promptly for signs of infection, such as spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or if a wound is rapidly worsening.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis, or a deep or severely contaminated wound.
- If you are overwhelmed or in emotional crisis, call or text 988 to reach the 988 Lifeline.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Frequently asked questions
What are the pressure injury stages?
Pressure injuries are commonly described as Stage 1 through Stage 4, based on how deep the tissue damage goes. Stage 1 is intact skin with persistent redness, Stage 2 is partial skin loss, Stage 3 is full-thickness skin loss, and Stage 4 is deeper loss that may involve muscle or bone. Unstageable and deep tissue pressure injuries are additional categories, and a clinician must assign the stage.
What does a Stage 1 pressure injury look like?
A Stage 1 pressure injury is generally intact skin with redness that does not fade when pressed. On darker skin the change may look different, such as a purple or darker area, or a change in warmth or firmness, so it can be harder to spot. A licensed provider can evaluate any suspicious area.
What is the difference between Stage 3 and Stage 4 pressure injuries?
A Stage 3 injury is full-thickness skin loss where fat may be visible, while a Stage 4 injury goes deeper and may expose muscle, tendon, ligament or bone. Exposed bone or tendon can be an emergency, so call 911 or go to the ER. A clinician can explain what a specific stage means for care.
What is an unstageable pressure injury?
An unstageable pressure injury is one whose depth cannot be determined because the wound base is covered, often by dead tissue. A clinician may need to remove some of that tissue before the wound can be staged. Evaluation by a wound care specialist is important.
Can a pressure injury change stages?
Yes, a pressure injury can be re-assessed over time as it changes, and clinicians track those changes. A worsening wound, or any sign of infection such as spreading redness, pus, foul odor, fever or chills, should prompt you to seek medical care promptly. Ask your provider how they will monitor the wound.
When should I see a wound care specialist for a bed sore?
It is reasonable to have any suspected pressure injury evaluated by a licensed provider, ideally early. Ask about the wound's cause, staging, treatment options, expected healing time and insurance coverage. Seek care promptly for signs of infection or rapid worsening, and call 911 for emergencies such as heavy bleeding or exposed bone or tendon.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.