Living With a Spinal Cord Injury - Pressure Sores
Pressure sores (bed sores) are an
injury to the skin and the tissue under the skin. They are a frequent and
sometimes serious complication of a
spinal cord injury (SCI). They can range from mild
reddening of the skin to severe
complications, such as infection of the bone (osteomyelitis) or blood (sepsis). They
can be hard to treat and slow to heal.
In people with SCIs,
the nerves that normally signal discomfort and alert you to relieve pressure by
changing position may no longer work. It is important for you to pay attention
to possible pressure sores and change your position frequently when you are
sitting or lying down.
Pressure sores are usually caused by
unrelieved pressure. They often develop on skin that covers
bony areas (such as the hips, heels, or tailbone). Constant pressure on the
skin reduces blood supply to the skin and to the tissues beneath the skin.
Oxygen and nutrients carried by the blood cannot reach the cells in the tissue,
eventually causing cell death, breakdown of the skin, and a pressure sore.
Other causes may include friction, which is the rubbing that
occurs when a person is pulled across bed sheets or other surfaces, and shear,
which is movement (such as sliding down a chair) that causes the skin to fold
over itself, cutting off the blood supply and possibly causing pressure
Pressure sores are described in four
- Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose color briefly when you press your finger on it then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer
or softer than the area around it.
- At stage 2, the skin usually breaks open,
wears away, or forms an ulcer, which is usually tender and painful. The sore
expands into deeper layers of the skin. It can look like a scrape (abrasion) or
a shallow crater in the skin. Sometimes this stage looks like a blister filled
with clear fluid. At this stage, some skin may be damaged beyond repair or may
- In stage 3, the sore gets worse and
extends into the tissue beneath the skin, forming a small crater. Fat may show
in the sore, but not muscle, tendon, or bone.
- At stage 4, the pressure sore is very
deep, reaching into muscle and bone and causing extensive damage. Damage to
joints may occur.
Pressure sores are usually diagnosed with a physical exam.
skin and wound culture or a
skin biopsy may be done if your doctor thinks you may
have an infection.