A Kennedy wound, also known as a Kennedy Terminal Ulcer (KTU), is a specific type of skin breakdown that appears suddenly in individuals nearing the end of life. Unlike typical pressure injuries that develop over time from external pressure, a Kennedy wound signals the body’s internal systems declining as part of the dying process. Its rapid onset makes it distinct from other skin conditions.
Identifying a Kennedy Wound
Kennedy wounds exhibit characteristic features that help distinguish them from other skin injuries. They often appear with irregular borders and can take on specific shapes, such as a pear, butterfly, or horseshoe. These wounds commonly develop on the sacrum or tailbone, but can also be found on other bony prominences like the heels, elbows, shoulders, or hips.
The coloration of a Kennedy wound can vary, presenting as shades of red, purple, black, yellow, maroon, blue, or orange. It may initially resemble a bruise that darkens quickly, sometimes progressing to a deep tissue injury appearance. A rapid progression is common, often appearing within just 24 to 48 hours. This sudden development has led some to refer to it as the “3:30 Syndrome,” where intact skin in the morning can become a noticeable wound by mid-afternoon.
Why Kennedy Wounds Occur
Kennedy wounds are not primarily caused by external pressure, unlike typical pressure ulcers. They are instead an internal manifestation of the body’s overall decline during the end-of-life process. This phenomenon is often described as “skin failure” or “Skin Changes at Life’s End” (SCALE), where the skin, as the body’s largest organ, begins to fail alongside other organ systems.
As death approaches, the body’s ability to maintain skin integrity diminishes due to reduced blood flow and oxygen supply to peripheral tissues. Blood is preferentially shunted to core organs like the brain and heart, leading to decreased perfusion in the skin. This physiological change makes the skin susceptible to breakdown, even with optimal care. Kennedy wounds are unavoidable in terminally ill patients.
Significance and Care Considerations
The presence of a Kennedy wound often signifies that death is imminent, typically within days or weeks. Recognizing this type of wound as part of the natural dying process helps shift the focus of care. The goal transitions from aggressive healing to ensuring the patient’s comfort, managing pain, and preserving dignity.
Care for Kennedy wounds prioritizes palliative measures rather than attempts at cure. This includes gentle handling, using pressure-relieving dressings and surfaces, and administering pain medication. Managing any associated odors also contributes to patient comfort. Emotional support for families is also important, helping them understand these wounds are an unavoidable part of the end-of-life journey.