Pressure ulcers, also known as pressure sores or bed sores, are areas of localised damage to the skin and underlying tissues caused by prolonged pressure, shear or friction. They most commonly develop over bony prominences such as the heels, sacrum, hips and elbows, particularly in people with reduced mobility due to illness, injury or prolonged hospital admission. Pressure ulcers are largely preventable and are recognised as a major patient safety issue within healthcare.
Key message — early recognition and emergency surgical treatment are the most important factors influencing recovery from compartment syndrome. Once the affected tissues have been decompressed, structured multidisciplinary rehabilitation plays a vital role in restoring movement, strength, function and independence while identifying and managing any permanent complications.
Prolonged immobility, inadequate repositioning, reduced sensation, poor nutrition, moisture, medical devices, prolonged hospital admission
Persistent redness, skin breakdown, blistering, pain, discolouration, open wounds, tissue loss or infection
Clinical assessment, pressure ulcer staging, skin inspection, nutritional assessment and infection assessment where indicated
Pressure relief, specialist wound care, dressings, infection management, surgery for severe ulcers, nutritional optimisation and rehabilitation
Physiotherapy, occupational therapy, pressure management, mobility training, seating assessment, equipment provision and education
Varies from several weeks for superficial ulcers to many months for severe Stage 3 or Stage 4 ulcers requiring surgery
Infection, cellulitis, osteomyelitis, sepsis, chronic pain, delayed healing, recurrent ulceration and reduced independence
Early recognition and emergency surgical treatment are the most important factors influencing recovery from compartment syndrome. Once the affected tissues have been decompressed, structured multidisciplinary rehabilitation plays a vital role in restoring movement, strength, function and independence while identifying and managing any permanent complications.
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Pressure relief, skin assessment, wound management, risk assessment and prevention of further tissue damage
Regular repositioning, specialist equipment, nutritional optimisation, pain management and early mobility where appropriate
Progressive wound healing, increasing mobility, strengthening, transfer practice and independence with daily activities
Healing of deeper ulcers, ongoing physiotherapy and occupational therapy, equipment review and return to functional activities
Long-term recovery, prevention of recurrence, management of any permanent disability and optimisation of independence
Recovery varies considerably according to ulcer severity, underlying medical conditions, nutritional status and the individual’s ability to participate in rehabilitation.
Most pressure ulcers are preventable through regular repositioning, good skin care, pressure-relieving equipment, adequate nutrition and early identification of individuals at risk.
Small superficial ulcers may heal within several weeks, whereas severe Stage 3 or Stage 4 ulcers can require many months of treatment and rehabilitation. Some may require reconstructive surgery.
Dressings are selected according to the stage of healing and wound characteristics. The type of dressing often changes as the wound improves.
Activity is usually encouraged where appropriate, provided pressure on the affected area is adequately managed. Rehabilitation programmes are tailored to protect healing tissues while maintaining overall fitness and function.
Recurrence commonly occurs if pressure relief strategies, seating, mobility, nutrition or skin care are not maintained. Ongoing prevention remains essential even after healing.
Return to work depends upon wound healing, mobility, sitting tolerance, underlying medical conditions and occupational demands. Many people benefit from a phased return supported by occupational health or vocational rehabilitation.
Bed sores, pressure sores, pressure wounds, skin sores from lying in bed, pressure injuries.
Although pressure ulcers are often viewed as wounds requiring specialist dressings, successful recovery depends upon much more than wound care alone. Restoring movement, improving nutrition, optimising pressure management and supporting psychological wellbeing are equally important in achieving long-term functional recovery.
Where pressure ulcers have resulted from delayed recognition or inadequate preventative care, rehabilitation should address both the physical consequences of tissue injury and the wider impact on independence, quality of life and future health. Early multidisciplinary intervention and continued vigilance remain the most effective strategies for reducing disability and preventing recurrence.
For more detailed information about this injury, its treatment and rehabilitation, download our free Rehabilitation Guide.
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People interested in this injury also find the following related rehabilitation guides useful:
You may also wish to explore the organisations and publications that informed this guide.