Pressure Ulcer


What is a Pressure Ulcer

Bedsores — also called pressure ulcers and decubitus ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.

People most at risk of bedsores have medical conditions that limit their ability to change positions or cause them to spend most of their time in a bed or chair.

Bedsores can develop over hours or days. Most sores heal with treatment, but some never heal completely. You can take steps to help prevent bedsores and help them heal. 

Prevalence: 4-8% of those that receive healthcare in New Zealand experience a pressure injury1 

Incidence: 55,000 people receive a PI annually in the New Zealand health sector


A pressure ulcer is caused by a lack of blood flow due to mechanical stress on the skin and tissues over a bony area that has been under pressure for a prolonged period. If the blood supply is cut off to an area of skin for more than 2–3 hours, the skin is deprived of oxygen and begins to die.

Four primary contributing factors for bedsores are:

  • Pressure. Constant pressure on any part of your body can lessen the blood flow to tissues. Blood flow is essential for delivering oxygen and other nutrients to tissues. Without these essential nutrients, skin and nearby tissues are damaged and might eventually die.

    For people with limited mobility, this kind of pressure tends to happen in areas that aren't well padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.

  • Friction. Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
  • Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.
  • Moisture. Excessive exposure to moisture, such as sweat, blood, urine or faeces, also increases the likelihood of developing a pressure ulcer.

Pressure ulcers

Pressure Injuries - Dermatologic Disorders - MSD Manual Professional Edition


Warning signs of bedsores or pressure ulcers are:

  • Unusual changes in skin color or texture
  • Swelling
  • Pus-like draining
  • An area of skin that feels cooler or warmer to the touch than other areas
  • Tender areas


Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from changes in skin color to a deep injury involving muscle and bone.

Pressure ulcers are classified into stages according to wound severity.

Stage 1

  • Skin is unbroken but shows a pink or reddened area
  • May look like a mild sunburn
  • Skin may be tender, itchy or painful

Stage 2

  • Skin is red, swollen and painful
  • Blisters may be present
  • Upper layers of skin begin to die

Stage 3

  • Ulcer has broken through the skin and wound extends down to deeper layers of skin tissue
  • Crater-like ulceration is present
  • Wound is prone to infection

Stage 4

  • Sore extends past the skin and into fat, muscle and bone tissue
  • Blackened dead tissue called eschar may be seen in deep open wounds
Stages of pressure sores. Image Credit: Alila Medical Media / Shutterstock

What is the treatment for a pressure ulcer?

Evidence suggests that up to 95% of PI are avoidable when appropriate interventions are in place.

A pressure ulcer can be difficult to treat once it has gone beyond stage 2. In the early stages when the skin is still intact, a pressure ulcer usually heals by itself if the pressure has been removed. Once the skin is broken, the main aim is to prevent infection and protect the sore so that it can heal. Dead tissue may be removed with a scalpel (debridement).

Deep pressure ulcers are very difficult to treat and often require surgical treatment to remove dead and decaying tissue.

  • Healthy skin may be grafted onto the damaged area.
  • Infection needs treatment with antibiotics
  • In severe or life-threatening situations, amputation of a limb may be necessary.


  • Avoid and correct malnutrition if present (fluid, energy, protein, vitamins and minerals)
  • Daily inspection of the skin to detect early redness
  • Frequent repositioning (every 2 hours)
  • Maintaining skin hygiene
  • Special foam, fibre and gels used as padding materials on chairs and beds to relieve the pressure on bony prominences
  • Powered alternating-pressure mattresses and overlays.
Prevention of pressure ulcers

Our solutions 

Levabo Heel up® and All up® - Single-patient inflatable positioning cushions.

Heel up® and All up® is suitable for effective prevention and treatment of pressure ulcers in high-risk areas such as heels, hips, elbows, shoulders, back, etc

Levabo Turn All 

Automated anti decubitus lateral turning system for pressure ulcer prevention. Automatic side positioning system 0-30 degrees for pressure ulcer prevention or treatment


The Trulife range of pressure relieving positioning devices were developed as a result of their commitment to provide improved levels of pressure care for patients and undergoing Theatre procedures.


Protects the limbs from skin tears and skin damage. It is light in weight and yet bulky enough to protect.