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Stage 3
How to recognize: The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in stage 2.
What to do: Follow steps 1-4 under stage 1 and the additional steps under stage 2. Always consult your health care provider. Wounds in this stage frequently need additional wound care, such as: special cleaning agents (half-strength hydrogen peroxide or dilute Hibiclens), debriding agents (such as Elase), irrigations (forceful cleansing of the wound bed), and/or packing of the wound bed (DuoDERM granules, moist gauze), occasionally an antibiotic (oral pills or Silvadene cream) may be used. Your health care provider will order what is appropriate for you
Stage 4
How to recognize: The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.
What to do: Consult your health care provider right away. Surgery is frequently required for this type of wound.
How to know if the sore is healing
The sore will get smaller. Pinkish tissue usually starts forming along the edges of the sore and moves toward the center; you may notice either smooth or bumpy surfaces of new tissue. Some bleeding may be present. This shows that there is good blood circulation to the area, which helps healing.
Signs of trouble
You need to seek help if any of the following occurs:
An increase in the size or drainage of the sore. Increased redness around the sore or black areas starting to form. The sore starts smelling and/or the drainage becomes a greenish color. You develop a fever
What kind of complications can be caused by pressure sores?
Reapplying pressure:
Only when a pressure sore is completely healed can pressure be reapplied over the area. Complete healing means that the outer layer of skin (the epidermis) is unbroken and normal coloring has returned to the area. Sometimes a scar may remain. A scar is healed tissue but will remain a somewhat different color from the surrounding skin. Scar tissue is never as tough as uninjured skin.
The first time pressure is applied to a newly healed area, it must be for a very short time (15 minutes at most). Then remove pressure from the area and inspect it for redness (erythema). If there is redness, observe it and time carefully how long it takes to fade to the color of the surrounding tissue (or the color it was before the pressure was applied in the case of a scar). If fading occurs in 15 minutes or less, no damage has occurred. Wait at least one hour and repeat pressure application.
After three successful 15-minute trials, increase to 30 minutes and repeat the above process using the guideline of a 15-minute or less fading time as a successful trial. After three successful 30-minute trials, you may increase the time by 30 minutes each day. If at any point a trial is not successful, hold at that level until three successful trials are accomplished. In this way, you will rebuild your skin pressure tolerance.
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