The Stages of a Bed Sore

  BED SORE STAGES DEFINED 

Pressure can be reduced through the use of the recommended alternating pressure mattress systems. These specific models are approved by medicare under code E0277. The following alternating pressure mattresses are designed to heal stages 1-4 bed sores and pressure ulcers. 

The PM8080 Hospital Alternating Pressure mattress system 

8000 Group II Series Alternating Pressure Low air Loss Mattress 

True Low Air loss Medical Mattress System 

  Stage I: An observable, pressure-related alteration of intact skin, whose indicators as compared to an adjacent or opposite area on the body may include changes in one or more of the following parameters:

• Skin temperature (warmth or coolness);
  
• Tissue consistency (firm or boggy);
  
• Sensation (pain, itching); and/or
  • A defined area of persistent redness in lightly pigmented skin, whereas
    in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.
    Stage I pressure ulcers may be difficult to identify because they are not readily visible and they present with greater variability. Advanced technology (not commonly available in nursing homes) has shown that a Stage I pressure ulcer may have minimal to substantial tissue damage in layers beneath the skin’s surface, even when there is no visible surface penetration. The Stage I indicators identified below will generally persist or be evident after the pressure on the area has been removed for 30 to 45 minutes.
    
  
  
  
  
   
  0. Stage II: Partial-thickness skin loss involving epidermis, dermis, or both.
     The ulcer is superficial and presents as an abrasion, blister, or shallow crater.
     Stage III: Full-thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater, with or without undermining of adjacent tissue.
     Stage IV: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts may also be associated with Stage IV pressure ulcers. 
     
     
     
     
      STAGE 1
     By the definition in Tag F314 - regardless of color, temperature, consistency, or sensation - the skin of a Stage I pressure ulcer is intact. If the skin is dark purple or very deep in color but intact, it may be a deep tissue injury or DTI. DTI is not a simple Stage I, it could indicate that the damage is deeper, including subcutaneous tissue, muscle, bone, joint capsule or other supporting structures. Unlike a Stage I (that is caught in a timely fashion), a DTI may not resolve or improve with prevention measures like offloading. Confusion also lies in the classification of Stage II (partial-thickness) and Stage III or IV (full-thickness) pressure ulcers. To clear things up, use the following assessment criteria.
     Stage II (Partial-Thickness) Pressure Ulcers:
     

     • Cannot have, or ever have had, slough or eschar (necrotic tissue)
       
     • Heal by regeneration of the dermis and epidermis
       
     • Heal without granulation tissue
       
     • Have a “flat” edge
       
     • Have no undermining or tunneling
       
     • Heal without scarring
       If the injury goes through the epidermis and into, but not through, the dermis, it is a Stage II (partial-thickness) wound. If there is any necrotic tissue in the wound, it cannot be a Stage II ulcer. Also, the wound edge in a Stage II pressure ulcer will be at the same height as the intact skin. As long as all wound healing factors have been addressed, these ulcers often heal quickly. Each hair follicle acts as a “wound edge.” The epithelial cells lining the follicle migrate, allowing tissue to regenerate, and spread out from each hair follicle.
       Stage III or Stage IV (Full-Thickness) Pressure Ulcers:
       
       • May have slough or eschar (necrotic tissue)
         
       • Heal by filling in with granulation tissue, followed
         by epithelialization and contraction
         
       • Will not have regeneration of dermis and epidermis
         
       • Have a “healing ridge” at the edge
         
       • May have undermining or tunneling
         
       • Heal with scar formation
         A Stage III or Stage IV pressure ulcer goes through the epidermis and the dermis. The dermis itself never regenerates. The void or “dead space” must fill with new granulation tissue (beefy, red, bumpy tissue) whose blood supply comes from
         a process called angiogenesis (the formation of new blood vessels). Full-thickness wounds only heal from the edges inward; this is why they take longer to heal. The granulation tissue needs to reach skin surface before epithelialization
         and contraction or resurfacing can occur. 
         
         more information about products to treat and heal bed sores at 
         
         www.alternatingpressuremattress.com
         www.medicalairmattress.com 
         
         
         
         
         
         References
         CMS Manual System. Department of Health & Human Services (DHHS), Centers for Medicare & Medicaid
         Services (CMS). Pub. 100-07, State Operations Provider Certification. Transmittal 4. November 12, 2004. Martin P. Wound healing: aiming for perfect skin regeneration. Science. 1997;276 (4):75.
         Mast BA, Schultz G. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds.
         Wound Repair and Regeneration. 1996;4(4):411.
         National Pressure Ulcer Advisory Panel www.NPUAP.org
         Wound, Ostomy, Continence Nurses Society www.WOCN org
         Wysocki AB. Anatomy and physiology of skin and soft tissue. In: Bryant RA, ed. Acute & Chronic Wound
         Nursing Management. 2nd ed. St. Louis, Mo: Mosby; 2000:1.