What is the difference between a Stage 1 pressure sore and a Stage 4 pressure sore?

A pressure sore is an injury to the skin that occurs when a patient lies or sits too long in the same position. Pressure keeps blood from getting to the tissue, causing cells to die and the skin to break down.  As the tissue dies, an open sore forms. In severe cases, the muscle, tendon, or bone may begin to show.

Pressure sores usually occur on bony areas of the body, such as the tailbone, back, buttocks, elbows, heels, hips and shoulders.  If you spot them early, you can stop them from forming or prevent them from getting worse.

What are the stages of pressure sores?

The doctor or nurse can tell how bad the pressure sore is by looking at the skin and measuring the sore. Each  pressure sore is graded (this is called staging) based on the amount of breakdown to the skin.

The skin is made up of two layers: the epidermis and the dermis.  The epidermis is the thin, tough outer layer.  The epidermis has no blood vessels. The dermis is the thick inner layer that attaches to the tissue beneath.  The dermis contains blood vessels, hair follicles, oil glands, sweat glands and nerve endings. Underneath the dermis are fatty tissue, muscle, blood vessels, nerves and bone.

A Stage I pressure sore is the earliest stage of a pressure sore.  With a Stage I pressure sore, the area over a bony body part may look red.  The area may be painful and feel warmer or cooler than the skin around it.  In Stage I, the skin is not broken.

With a Stage II pressure sore, the outer layer of skin blisters or forms a shallow open sore.  The formation of a blister on the skin is the distinguishing feature of a Stage II pressure sore.

A Stage III pressure sore is a more advanced sore.  The area below the skin, including the nerves, is damaged by the blister, and the sore looks like a crater.  Fat may be visible, but bone and muscle cannot be seen.

The most advanced pressure sore is a Stage IV pressure sore.  This is a deep wound and you can see muscles, tendons and bone.

Certain pressure sores are considered "unstageable".  This occurs when the top layer of the sore is covered by dead tissue, which can have a yellow, tan, gray, green or brown color.  It may also look like a scab.  The dead tissue or scab covers a deeper, more serious wound and needs to be removed by a doctor.  The removal of the dead tissue is essential to healing and is known as a surgical debridement.

With proper care and treatment, pressure sores should never advance beyond Stage I or II.  The federal government considers Stage III and IV pressure sores to be "never events" (injuries that only occur as the result of medical neglect) and the government refuses to pay for the treatment of such ulcers under Medicare and Medicaid.

If you have any questions about pressure sores, I welcome your phone call on my toll-free cell at 1-866-889-6882 or you can send me an e-mail at [email protected] .