Bedsores are very common in nursing homes and are sometimes confused with deep tissue injuries because the two share many signs and symptoms. However, the two are separate, but related, injuries, with both requiring different types of care. It is important to know the differences between the two because deep tissue injuries can rapidly deteriorate into more severe ailments, or even convert into a stage II, III, or IV pressure ulcer. Even with proper treatment, sometimes other layers of skin near a deep tissue injury can become affected as well, ultimately worsening the wounds. A review of the four stages of bedsores can be found here.
Deep Tissue Injuries
Deep tissue injuries (DTI) can be dark purple or maroon-colored areas on or under the skin that appear similar to a deep bruise or a blister filled with blood. Blood blisters are due to damage from pressure and/or shear forces sustained by the soft underlying tissue just below the outer skin layer. These injuries can be painful when touched, and maybe warm to the touch, sensitive, and feel plump. In people with darker skin, blood blisters may be harder to visually detect, as they can match the dark color of the skin. These types of blisters sometimes form a second clear, serum-filled blister on top of the blood-filled blister, or may form a layer of eschar on top.
DTIs are usually slow onset. Because they are similar to a very slow bleed, they can develop as late as a day after an injury occurs. There are several skin conditions that can be classified as DTIs, including bruises, calciphylaxis (avascular calcification and skin necrosis associated with renal failure), hematomas (very deep bruising, usually deep in the muscle tissue), Fournier’s gangrene (necrotizing fasciitis affecting the perineum), or a perirectal abscess.
Identifying the Differences
DTI vs. Stage I: The main difference between a stage I bedsore and a DTI is that the symptoms of a stage I bedsore will go away within 24 hours if the pressure is relieved, whereas a DTI will not recover in this amount of time. Instead, relieving the pressure may prompt a DTI to convert into a stage II bedsore.
DTI vs. Stage II: DTIs and stage II bedsores are often confused because stage II bedsores include blisters and blistering lesions. If a DTI presents a blister, either blood-filled or serum-filled, it is appropriate to consider it a stage II bedsore. However, some DTIs do not present blisters, and/or fester under the skin for days. Suddenly, the DTI will deteriorate the upper layers of skin, leaving behind a deep crater-like wound, similar to a stage III bedsore, or if the wound is deep enough, a stage IV bedsore. These types of DTIs should not be considered stage II bedsores.
DTI vs. Stage III and Stage IV: By the time a DTI morphs into an open wound by sloughing off the outermost cutaneous skin layers to reveal the extent of the tissue damage underneath, the DTI and stage III or stage IV bedsore unify and treatment for one is the same.
If your loved one has suffered from a bedsore while residing in a nursing care facility, please do not hesitate to contact The Rooth Law Firm today online or at (800) 350-0646.
Laurie Swezey, What is a Deep Tissue Injury?, August 6, 2013
National Pressure Ulcer Advisory Panel, Deep Tissue Injury, 2012 White Paper