Dr. Jerry Laster, MD Q & A

Understanding Pressure Ulcers

Author: Dr. Japa Volchok, DO

In this segment, wound care physician, Dr. Jerry Laster, M.D. answers our questions and explains pressure ulcers in depth.

Dr. Laster describes the differences between the four stages of pressure ulcers, why these wounds commonly occur and the types of patients that usually get these wounds.

Where do pressure ulcers typically develop on the body?

Pressure ulcers can occur anywhere. But, most commonly they’re going to be on boney prominences that do weight support. The tailbone, the ischium which is where you’re actually sitting or where I’m actually sitting right now. If they’re lying in bed, their shoulder blades their elbows, their knees, their ankles, their feets and heels. Any place where there is pressure and contact that can impede blood flow to that area can lead to a pressure wound. You also have to be very careful because of a lot of orthopedic devices, braces, slings, casts, can put pressure on the skin and can cause a wound as well.

Why do pressure ulcers develop around boney prominences?

Those boney prominences are holding the weight. And, if there’s pressure on it. If I push on you with my knuckle for a little period of time, it will eventually become uncomfortable to you and you’ll move away from it. Some of these people have impaired sensation, and their sensorium is impaired. And, they don’t recognize that pressure. Or, they have diabetes in their feet and they have a neuropathy so they don’t feel pain like you or I do. And, the pressure over a boney prominence acts like a tourniquet and cuts off the blood supply and the tissue actually dies.

What is a Stage 2 Pressure Ulcer?

A stage 2 ulcer is a very partial injury into the skin. And the skin has various thicknesses throughout the body. It can be very thin in places like the inner thigh or on your face. It can be very thick on your back. So, a stage 2 wound, it’s not how deep it is in terms of a measurement in millimeters. It’s actually whether it’s all the way through the dermis. If it’s not all the way through the dermis then it’s a stage 2 wound.

What is a Stage 3 Pressure Ulcer?

A stage 3 wound means the entire skin or dermis and epidermis have been disrupted into the fat. But, you’re not disrupting anything below the muscle fascia or not disrupting the muscle fascia. So, you’re really dealing with just deep subcutaneous tissue.

What is a Stage 4 Pressure Ulcer?

A stage 4 pressure ulcer is one in which you are looking at either tendon, ligaments, bone, muscle. Anything below the subcutaneous fat layer is considered a stage 4 wound.

Why do geriatric patients develop pressure ulcers more than younger patients?

Certainly, you see more pressure ulcers in the older population because they tend to be immobilized more frequently. Although, young people that have conditions like multiple sclerosis, spina bifida, spinal cord injuries, bad injuries from a car wreck or a trauma where they’re lying in bed for a long period of time. They also can develop it. But, as we get older, our skin integrity is not as good as it is when we are young. That’s why we develop wrinkles and our skin gets thin.

Nutrition tends to be an issue. Older people don’t tend to stay hydrated as well. They don’t have the sense of thirst like a younger person does. They tend to have more concomitant medical conditions, diabetes, high blood pressure, kidney problems, peripheral arterial disease. They’re on medications that affect skin adversely, like steroids, or chemotherapy drugs or gout drugs or arthritis medications. All those can have an adverse effect on the skin.

Watch the full segment here: https://youtu.be/JUxlkykWTzk

Physician Careers

Wound Care Certification

Wound Care for SNFs

at Home

Author: Dr. Japa Volchok, DO

Dr. Volchok is the Vice President of Operations at Vohra Wound Physicians. Trained as a vascular and general surgeon he joined Vohra in 2009. Dr. Volchok is currently responsible for Vohra’s telemedicine program, legal and regulatory matters, and physician recruitment. He completed an executive management program at the Harvard Business School.