pressure on a specific area of the body (eg the heels ,
the hips) will affect the to the skin and underlying
tissues causing that area to become damaged.
Mild tissue damage results in skin discolouration, giving
a brown or purple appearance. This may look darker if the
skin is very fair.
More severe pressure ulcers can expose muscle and even bone.
The area around the dead tissue will look red and inflamed
and may become infected.
recognised grades of pressure ulcers in the EPUAP Wound
|• GRADE 1: Discolouration
of intact skin not affected by light finger pressure
(non blanching erythema)
This may be difficult to identify in darkly pigmented
|• GRADE 2: Partial-thickness
skin loss or damage involving epidermis and/or dermis.
The pressure ulcer is superficial and presents clinically
as an abrasion, blister or shallow crater.
|• GRADE 3: Full
thickness skin loss involving damage of subcutaneous
tissue but not extending to the underlying fascia.
The pressure ulcer presents clinically as a deep crater
with or without undermining of adjacent tissue.
|• GRADE 4: Full
thickness skin loss with extensive destruction and necrosis
extending to underlying tissue.