The Staging System for Pressure Ulcers
Pressure ulcers are classified into a standardized staging system to describe the extent of tissue damage. This classification system helps healthcare professionals assess the severity of the wound and guides the appropriate course of treatment. The system typically ranges from Stage 1 through Stage 4, with additional categories for unstageable pressure ulcers and deep tissue injuries.
Visual Characteristics of a Stage 3 Ulcer
A Stage 3 pressure ulcer involves full-thickness tissue loss. In this stage, subcutaneous fat may be visible within the ulcer, appearing yellowish. However, bone, tendon, or muscle are not yet exposed, which distinguishes it from more severe stages. The wound often presents as a deep crater, reflecting the significant loss of tissue.
The base of a Stage 3 ulcer may contain slough (dead tissue that can be yellow, tan, gray, green, or brown). Eschar, a dark, leathery dead tissue, may also be present within the wound bed. The presence of slough or eschar indicates tissue necrosis and can obscure the true depth of the wound. These non-viable tissues require removal to allow for proper healing.
Undermining and tunneling are common features. Undermining is a pocket under the skin at the wound’s edge, where the skin surface remains intact but the tissue underneath has eroded. Tunneling describes a channel that extends from the main wound into the surrounding tissues. Both undermining and tunneling indicate extensive tissue destruction beneath the visible surface of the wound.
The edges of a Stage 3 ulcer may appear rolled, known as epibole, where the wound edges curl under themselves. Surrounding skin might show signs of redness, warmth, or swelling due to inflammation or infection. Foul odor or discharge from the wound can also indicate the presence of infection.
How Stage 3 Compares to Other Stages
Understanding the distinct features of a Stage 3 pressure ulcer is clearer when compared to other stages of wound development. A Stage 1 pressure ulcer is characterized by intact skin with non-blanchable redness, meaning the skin does not turn white when pressed. There is no open wound or tissue loss at this point.
A Stage 2 pressure ulcer involves partial-thickness skin loss, affecting the epidermis and possibly the dermis. It often presents as a shallow open ulcer with a red-pink wound bed, or as an intact or ruptured serum-filled blister. Unlike Stage 3, subcutaneous fat is not visible in a Stage 2 ulcer. The presence of a blister or a superficial open wound are distinguishing signs for Stage 2.
In contrast, a Stage 4 pressure ulcer represents the most severe form of tissue damage. This stage involves full-thickness tissue loss with exposed bone, tendon, or muscle. The visibility of these deeper structures is the primary differentiating factor from a Stage 3 ulcer, where only subcutaneous fat may be visible. Stage 4 ulcers often include undermining and tunneling, similar to Stage 3, but with significantly greater depth and exposure of underlying anatomical structures.
What to Do Next
If a Stage 3 pressure ulcer is suspected, seek immediate medical attention. These wounds require professional assessment and management to prevent complications and promote healing. Attempting self-diagnosis or self-treatment can lead to worsening of the condition and potential infections.
A healthcare provider, such as a doctor or wound care specialist, can accurately stage the ulcer and develop an appropriate treatment plan. This plan typically involves wound cleaning, debridement to remove dead tissue, pressure redistribution, and infection control. Early intervention helps improve outcomes and reduces the risk of further health complications.