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Four Levels of Skin Breakdown

Jennifer A Gardner, PT, DPT, MHA, CWS

May 5, 2015

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Question

What are the levels of skin breakdown and how many are there?

Answer

There are four levels of skin breakdown.  The first level is hyperemia.  This can be seen within 30 minutes, usually appears as redness, and if you change the patient’s position and alleviate the pressure, usually the redness will be gone in approximately an hour.  Ischemia is where the tissue is starting to not get the blood flow it needs and that is when it can start to cause some skin damage.  This occurs after two to six hours of continuous pressure, and may actually take up to 36 hours to be alleviated once the pressure is removed, but it can be reversed.  The next level is necrosis.  This occurs after 6 hours of continuous pressure.  The skin may turn blue or gray and may become indurated or firm.  This necrosis may or may not disappear once the pressure is removed, and would actually lead to the ulceration which is level IV.  Ulceration may occur within two weeks after necrosis and you may get potential infection.  However it is important to keep in mind that it does not take up to two weeks for these pressure ulcers to occur.


jennifer a gardner

Jennifer A Gardner, PT, DPT, MHA, CWS

Dr. Gardner has been a physical therapist for 16 years with the last 11 concentrated solely on wound care. She became a Certified Wound Specialist in 2001 and recently successfully passed her re-certification in October 2011. Currently, Dr. Gardner is employed at Inspira Medical Center Woodbury in Woodbury, NJ as the Manager of Wound Care Services, supervising both inpatient wound care and the outpatient wound center. In addition, she has been adjunct professor at College of St. Scholastica in Duluth, MN for the last 8 years, teaching Integumentary to doctoral physical therapy students.  Dr. Gardner has presented both nationally and internationally on various wound care topics and continues to participate in research studies on new concepts in wound healing.


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