Evolution of Deep Tissue Pressure Injury

View the graphic here. 

Deep tissue pressure injury remains one of the most serious forms of pressure injury. The pressure is exerted at the muscle-bone interface, but due to the resiliency of the skin, the color change is not immediate, in contrast to a bruise. The process leading to deep tissue pressure injury precedes the visible signs of purple or maroon skin by about 48 hours. Then about 24 hours later, the epidermis lifts and reveals a dark wound bed. This phase of deep tissue injury evolution is often confused with skin tears. Within another week, the wound bed is often necrotic. The lag between the “pressure event” and the change in color of the skin makes the root cause analysis complex. The National Pressure Injury Advisory Panel (NPIAP) has created the photographic timeline shown above to help clinicians more reliability determine the events leading to deep tissue pressure injury. It is important to be aware that 48 hours prior to the patient’s skin being deep red, maroon, or purple, he/she may not have been in your facility.