Case history
Case history #1
A 65-year-old man presents with fever and respiratory distress. He rapidly develops progressive hypoxia and hypotension requiring ventilator support and pressors. Efforts to reposition the patient result in marked desaturations. One week later, following stabilization of his medical condition, he is noted to have an extensive area of tissue damage over his sacral region. The damage around the margin of the wound appears relatively superficial, with some signs of partial skin loss. Toward the center, directly over the sacrum, is an area of necrotic tissue, which is starting to separate spontaneously, exposing a cavity containing viscous yellow slough. A purulent discharge is draining from this cavity.
Case history #2
An 80-year-old woman in a residential care facility, who has recently suffered a stroke with a resulting right hemiplegia, presents with a painful area on the right heel. On examination the heel is found to be covered with a layer of hard, black, necrotic tissue with a leathery appearance.
Other presentations
Pressure ulcers, while typically thought of as a condition of frail elderly patients, may occur among patients of any age and in any setting. When not located over a bony prominence, pressure ulcers are usually the result of an external device. Examples include oxygen tubing causing a pressure ulcer on the ear or a lower leg cast causing an ulcer on the leg. External devices may also cause mucosal pressure injury.
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