4 Bed Sores Stages | Bedsore Complications

What is Pressure Ulcer or Bedsore?

Pressure ulcer also called bedsore and decubitus ulcer is injuries to the skin and underlying tissue when there is friction or unrelieved pressure on one part of the body. Bedsore can develop on any part of the body, but the bony areas around the elbows, knees, heels, coccyx, and ankles are more susceptible. A bedsore is treatable, but without treatment, it can lead to fatal complications.

Bedsore stages
Fig: Bedsore stages

Different Stages of Pressure Ulcer or Bedsore:

The stages of pressure ulcer or bedsore are grouped by the severity of symptoms. If found early, there is a good chance to treat the sore easily and can heal in a few days, with little fuss or pain. Without treatment, they become worse and lead to life-threatening conditions. Pressure injuries are categorized into five stages, include:

Stage- I:

Non-branch able erythema of intact skin. In individuals with darker and discoloration of the skin may be purplish/bluish or violaceous (eggplant-like color) accompanied by heat, edema, induration, or hardness. Pain, burning, or itching are common symptoms.


Partial-thickness skin loss in which epidermis, dermis, or both may involve. The ulcer presents clinically as an abrasion, blister, or shallow crater, and superficial. Drainage (pus) or fluid leakage may or may not be present and it painful.


Full-thickness skin loss that involves the dermis (second layer of skin) into the fatty subcutaneous (below the skin) tissue, but not through the underlying fascia.  The sore clinically looks like a deep crater with or without undermining of adjacent tissue.  Bone, tendon, and muscle are not visible.


Full-thickness skin loss with comprehensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (i.e. tendon joint capsule). Undermining and sinus tracts are also associated with Stage IV ulcers. Skin becomes black and clinically shows signs of infection — red edges, pus, odor, heat, and/or drainage.

Stage V or Unstageable Pressure Ulcer:

Full-thickness tissue loss in which the base of the bedsore is covered by slough or necrotic tissue or black discolored tissues.it is difficult to define the stage. Staging requires the removal of eschar or slough to expose the wound depth.

Common Complications of Bedsore or Pressure Ulcer:

The development of pressure ulcers can lead to several complications. An open wound is unlikely to heal rapidly when a pressure ulcer is present with aerobic or anaerobic bacteremia, or both. The pressure ulcer is the primary source of the infection. Even when healing does take place, it may take a long time because of the damage to the skin and other tissues. Other complications of pressure ulcers include pain and depression and both are associated with delayed wound healing. Early-stage pressure ulcers often heal within a few weeks with proper treatment, but serious wounds may need surgery. Mortality is also involved with pressure-ulcer development during old age.  Thus, Careful assessment and treatment of a pressure ulcer are essential to minimize complications.

Complications of bedsores or pressure ulcers include the followings:

  1. Cellulitis: Cellulitis is an infection of the skin and connected soft tissues.
  2. Bone and joint infections: An infection from a pressure sore can burrow into joints and bones.
  3. Cancer: Long-term, non-healing wounds (Marjolin’s ulcers) can develop into a type of squamous cell carcinoma.
  4. Sepsis: Rarely, a skin ulcer leads to sepsis and symptoms.
  5. Anemia,
  6. Fistula formation (urethral, fecal),
  7. Osteomyelitis,
  8. Pyarthrosis (infectious arthritis),
  9. Autonomic dysreflexia (sudden onset of high blood pressure),
  10. Renal failure,
  11. Amyloidosis (progressive deposition of amyloid in organs),
  12. Bacteremia,
  13. Coma/death.

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