Deep Tissue Injury (DTI) is a form of pressure injury that originates in deeper tissues, often near bony prominences. These injuries develop from sustained pressure or shear forces, compromising blood flow to underlying soft tissues like muscle and fat. DTIs present a challenge for initial assessment due to their potential for rapid progression.
Understanding Deep Tissue Injury
A Deep Tissue Injury (DTI) involves damage to underlying soft tissue from intense or prolonged pressure or shear forces, often where muscle and fat are compressed against bone. Initially, a DTI appears as a localized area of discolored intact skin, typically deep red, purple, or maroon, or as a blood-filled blister. The skin remains unbroken, making it difficult to gauge the full extent of the damage beneath the surface.
The affected area may feel different from surrounding tissue, such as boggy, firm, or noticeably warmer or cooler. This distinct feel, along with pain, can sometimes precede visible discoloration. Common locations include the sacrum and heels, areas frequently subjected to pressure in individuals with limited mobility.
Why Deep Tissue Injuries Are Not Staged
Deep Tissue Injuries are distinct from other pressure injuries because they are not initially staged. They are classified as “Suspected Deep Tissue Injury” (sDTI) because the full extent of the damage cannot be visually determined while the skin remains intact. The discolored area indicates underlying injury, not a specific stage of tissue loss.
Unlike Stage 1 or Stage 2 pressure injuries, where visible skin changes allow for classification, a DTI’s depth is obscured. The deep red, purple, or maroon coloration reflects damage to deeper tissues, not necessarily the surface. A DTI can only be accurately staged after the skin breaks down and the underlying tissue is exposed, allowing for a clear assessment of tissue depth.
How Deep Tissue Injuries Evolve
Although initially unstageable, a Deep Tissue Injury can rapidly progress, often leading to superficial skin breakdown. Once the skin opens, the injury can be classified (staged) based on the exposed tissue depth, revealing the true extent of the damage. This means a DTI might evolve into a Stage 3, Stage 4, or an unstageable pressure injury if covered by slough or eschar.
While many DTIs progress to full-thickness tissue loss, some may resolve without skin breakdown, though this is less common for severe cases. The evolution of a DTI can be swift, sometimes revealing additional layers of tissue damage. Continuous monitoring and assessment are important to track the injury’s progression and guide appropriate interventions.