Healing Fact:

 More than 2.5 million people in the United States develop pressure injuries each year, and many are preventable with early recognition, regular repositioning, and good skin care.

Pressure injuries—often called bedsores or pressure ulcers—are among the most misunderstood wounds I encountered during my nursing career.

Many people assume they develop because someone wasn’t receiving good care.

Sometimes that’s true.

But often, the situation is much more complex.

I’ve cared for patients who developed pressure injuries despite excellent nursing care, specialized mattresses, frequent repositioning, and attentive families. I’ve also seen small areas of redness disappear completely because someone noticed them early and acted quickly.

Pressure injuries are not simply wounds.

They are injuries caused by prolonged pressure that reduces blood flow to the skin and underlying tissues.

Without enough oxygen and nutrients, those tissues begin to break down.

Understanding how this happens is one of the best ways to prevent it.

Who Is Most at Risk?

Anyone who remains in one position for long periods can develop a pressure injury.

The greatest risk is seen in people who have difficulty moving independently.

This includes:

• Older adults
• People recovering from surgery
• Patients confined to bed
• Wheelchair users
• Individuals with spinal cord injuries
• People living with advanced illness or significant weakness

Poor nutrition, dehydration, diabetes, poor circulation, and incontinence can all increase the risk because they make the skin more fragile and less able to recover from prolonged pressure.

Where Do Pressure Injuries Develop?

Pressure injuries usually occur over bony areas where there is very little cushioning between the skin and the bone.

Common locations include:

• Heels
• Tailbone (sacrum)
• Hips
• Ankles
• Elbows
• Shoulder blades
• Back of the head

Medical equipment can also create pressure injuries.

I’ve seen wounds develop beneath oxygen tubing, CPAP masks, casts, splints, and even medical stockings when pressure remained in the same place for too long.

Understanding the Stages

Not every pressure injury looks the same.

Stage 1 begins as skin that remains red, purple, or darker than the surrounding tissue and doesn’t return to its normal color when pressure is relieved. The skin isn’t open yet, but damage has already begun.

Stage 2 involves partial skin loss and may appear as a blister or shallow open wound.

Stage 3 extends deeper into the fatty tissue beneath the skin.

Stage 4 is the most severe, exposing muscle, tendon, or bone.

Some wounds cannot be staged immediately because dead tissue covers the wound bed. Others develop deep beneath the surface before the skin ever opens.

The important thing to remember is this:

The earlier a pressure injury is recognized, the easier it is to treat.

Prevention Is Powerful

One of the encouraging things about pressure injuries is that many can be prevented.

Small actions performed consistently often make the biggest difference.

Changing positions regularly helps restore blood flow to vulnerable tissues.

Special mattresses, wheelchair cushions, and heel protectors help reduce prolonged pressure.

Keeping the skin clean and dry protects it from moisture damage.

Eating enough protein and staying hydrated provides the body with the nutrients it needs to maintain healthy skin.

Daily skin checks are especially important for anyone who cannot easily see or feel vulnerable areas themselves.

Caregivers often become the first line of defense simply by noticing changes early.

Treatment Depends on the Stage

Once a pressure injury develops, treatment focuses on relieving pressure while supporting the body’s natural healing process.

That may include specialized dressings, careful wound cleaning, improved nutrition, moisture management, and treating any infection that develops.

More advanced wounds sometimes require wound vac therapy, surgical procedures, or consultation with a wound care specialist.

No single dressing heals every wound.

Successful treatment begins with identifying why the wound developed in the first place and removing the pressure that caused it.

When Should You Call Your Healthcare Provider?

Contact your healthcare provider if you notice:

• Skin that stays red, purple, or unusually dark after pressure is removed
• A blister or open sore
• Increasing drainage
• Foul odor
• Fever or chills
• Increasing pain
• Black or dead tissue
• Rapidly enlarging wounds

Never assume a pressure injury will improve on its own.

Early treatment almost always leads to better outcomes.

From a Nurse’s Perspective

I’ve cared for hundreds of pressure injuries throughout my career.

Some healed beautifully.

Others changed people’s lives forever.

What I learned wasn’t simply how to dress a wound.

I learned how quickly skin can change when someone is critically ill, malnourished, or unable to move.

I also learned something hopeful.

The patients who healed best weren’t necessarily the healthiest.

They were the ones whose care teams paid attention to the little things every single day.

Turning.

Checking the skin.

Encouraging nutrition.

Protecting the heels.

Asking for help early.

Pressure injuries rarely happen because of one big event.

They usually develop from many small moments that quietly add up over time.

The same is true for prevention.

Many small acts of attentive care can protect the skin long before a wound ever develops.

Healing Takeaway

Pressure injuries remind us that healing isn’t only about treating wounds—it’s about preventing them whenever possible.

If you or someone you love is spending more time in bed or a chair, don’t wait for an open wound to appear before taking action.

Protect the skin.

Keep the body moving whenever safely possible.

Support good nutrition and hydration.

And remember that the first sign of a pressure injury is often not an open sore, but simply skin asking for relief.

In our next article, we’ll explore surgical wounds and discuss what normal healing looks like after an operation—along with the warning signs that should never be ignored.