Pressure sores (bed sores) are an injury to the skin and underlying tissue. 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 difficult 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 underlying tissues. Oxygen and nutrients carried by the blood cannot reach the cells in the tissue, eventually causing cell death, breakdown of the skin, and development of the 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 sores.

Pressure sores develop in four stages:¹

• Stage 1 sores may be painful and tender. The skin may appear reddened or darker than normal, like a bruise, although there are no breaks or tears in the skin.
• At stage 2, the skin breaks open, wears away, or forms an ulcer. It is usually tender and painful. The sore expands into deeper layers of the skin. Some skin may be damaged beyond repair or die at this stage.
• During stage 3, the sore gets worse and moves into the tissue beneath the skin, forming a small crater. The sore usually is not painful at this stage, due to significant tissue damage. However, the risk of infection or tissue death is high.
• At stage 4, the pressure sore is very deep, reaching into muscle and bone and causing extensive damage. The sore is not usually painful at this stage, due to significant tissue death. Your deeper tissues, tendons, and joints may be damaged.

Pressure sores are usually diagnosed with a physical examination. A skin and wound culture or a skin biopsy may be done if your doctor thinks you may have an infection.

You or your caregiver can prevent pressure sores by using proper pressure-relieving supports and devices and changing your position frequently, whether you're in a bed or a wheelchair. For more information, see the topic Pressure Sores.

Contact your health professional if you:

• Notice an increase in the size or drainage of the sore.
• Notice increased redness around the sore or black areas starting to form.
• Notice that the sore begins to smell bad and/or the drainage becomes a greenish color.
• Develop a fever.

Treatment