Decubitus

Decubitus, commonly known as a pressure ulcer or bedsore, refers to localization of tissue damage that results from sustained pressure, friction, or shear forces, typically over a bony prominence. The condition is most commonly seen in people with limited mobility, such as those who are bedridden or wheelchair-bound, and can occur in any setting including hospitals, long-term care, and at home.

Pathophysiology involves prolonged occlusion of capillary blood flow due to external pressure, leading to tissue ischemia and necrosis. Risk factors include immobility, advanced age, malnutrition, dehydration, moisture from incontinence, diabetes, vascular disease, edema, and impaired sensory perception. Common sites are the sacrum, heels, greater trochanters, ischial tuberosities, and elbows.

Staging helps describe severity. Stage I features non-blanchable erythema; Stage II shows partial-thickness skin loss; Stage III involves full-thickness tissue loss with visible subcutaneous fat; Stage IV extends to muscle, tendon, or bone. Suspected deep tissue injury presents as a localized area of persistent non-blanchable color change. Some ulcers are unstageable when eschar or slough obscures depth.

Complications include infection (cellulitis, osteomyelitis, sepsis), chronic wounds, pain, reduced mobility, and impaired quality of life.

Prevention focuses on pressure redistribution and skin care: regular repositioning, specialized mattresses and cushions, meticulous skin inspection, keeping skin dry and intact, and ensuring adequate nutrition and hydration. Treatment combines relieving pressure with appropriate wound care, debridement as needed, moist wound healing, infection control, and management of underlying conditions. In severe cases, surgical reconstruction may be considered. The term pressure injury is increasingly used to emphasize prevention and prognosis.