Getting rid of bed sores requires a combination of pressure relief, wound care, nutrition, and time. A small, shallow sore caught early can heal in about three weeks with proper care, while deeper sores may take months and sometimes require surgery. The approach depends on how severe the sore is, but the fundamentals are the same: take pressure off the wound, keep it clean and moist, remove dead tissue, and give your body the fuel it needs to rebuild.
Identify How Deep the Sore Is
Bed sores (also called pressure injuries) are classified in four stages based on how much tissue has been damaged. Knowing the stage helps you understand what kind of care is needed and how long healing will take.
A Stage 1 sore is the earliest sign of trouble. The skin is still intact but shows a patch of redness that doesn’t fade when you press on it. On darker skin, the area may look discolored or feel warmer, harder, or slightly swollen compared to surrounding skin. At this point, the damage is fully reversible if pressure is removed.
A Stage 2 sore breaks through the top layer of skin. You’ll see a shallow, pink or red open wound, or possibly an intact or ruptured blister filled with clear fluid. These sores heal on average in about 23 days, though smaller wounds (under about 3 cm) tend to close roughly 12 days faster than larger ones. In a study of 270 patients with Stage 2 sores, just over half healed within the follow-up period, and about a quarter were still present after 10 weeks.
Stage 3 sores extend through the full thickness of skin into the fat layer beneath, creating a deeper crater. Stage 4 sores are the most severe, reaching into muscle, tendon, or even bone. Both of these stages take significantly longer to heal, often months, and typically need professional wound care or surgical intervention.
Relieve Pressure on the Wound
No sore will heal if it’s still being compressed. Removing pressure from the affected area is the single most important step in treatment.
For someone who is bed-bound, repositioning should happen at least every two hours. Clinical guidelines recommend turning at minimum every four hours for high-risk individuals and every six hours for those at moderate risk, but most treatment protocols for existing sores use a two- to three-hour schedule. A common approach is the 30-degree tilt method: alternating between the left side, back, right side, and back, using pillows or foam wedges to hold each position. This avoids placing weight directly on bony areas like the tailbone, hips, and heels.
For people who spend time in a wheelchair, shifting weight every 15 to 30 minutes is essential. Even small adjustments, like leaning to one side or doing a brief push-up off the armrests, can restore blood flow to compressed tissue.
Use a Pressure-Redistributing Surface
A standard hospital or home mattress concentrates too much force on bony prominences. Switching to a high-specification foam mattress is the baseline recommendation for anyone with an existing pressure injury. These mattresses distribute weight more evenly and reduce peak pressure points.
If a foam mattress isn’t enough, a dynamic support surface may be needed. These include alternating pressure mattresses, which inflate and deflate air cells in a cycle to shift pressure from one area to another, and low-air-loss mattresses, which circulate air to keep skin cool and dry. The evidence comparing these technologies is limited, but guidelines suggest stepping up to a dynamic surface when a standard foam mattress isn’t producing results.
Clean the Wound Properly
Each time the dressing is changed, the wound should be gently rinsed. Normal saline (a simple saltwater solution) or clean water are the standard choices. A Cochrane review of wound cleansing for pressure ulcers found no strong evidence that one cleansing solution is clearly better than another, but saline remains the most widely recommended option because it’s gentle and won’t damage new tissue.
Avoid using hydrogen peroxide, rubbing alcohol, or iodine-based solutions directly in the wound bed. These can destroy the fragile new cells trying to grow and slow healing rather than speed it up. If the wound needs more aggressive cleaning, low-pressure irrigation with saline (using a syringe to create a gentle stream) can flush out debris without harming healthy tissue.
Remove Dead Tissue
Dead tissue in a wound bed acts as a barrier to healing and a breeding ground for bacteria. Removing it, a process called debridement, is a key part of treating Stage 3 and 4 sores, and sometimes Stage 2 sores as well. There are several methods, each suited to different situations.
- Autolytic debridement is the gentlest approach. It uses the body’s own enzymes to break down dead tissue. Moisture-retentive dressings (like hydrogels or hydrocolloids) are placed over the wound to create a moist environment, and the body gradually softens and separates the dead tissue on its own. This method is highly selective, meaning it only affects dead tissue and leaves healthy tissue alone. It works best on non-infected wounds.
- Enzymatic debridement uses a topical enzyme, typically collagenase, applied directly to the wound. The enzyme digests the collagen fibers holding dead tissue in place, causing it to detach over days to weeks. It’s slower than hands-on methods but more targeted.
- Mechanical debridement uses physical force to remove dead tissue. This includes techniques like pulsatile lavage (pressurized saline irrigation) or wet-to-dry dressings. It’s effective for wounds with large amounts of dead tissue but is non-selective, meaning it can also remove some healthy tissue in the process.
- Surgical debridement is the fastest method. A healthcare provider uses instruments to cut away dead tissue. This is typically reserved for large, deep, or infected wounds where slower methods aren’t practical.
Keep the Wound Moist With the Right Dressing
The old idea of letting a wound “air out” doesn’t apply here. Pressure injuries heal faster in a moist environment, which supports cell migration and prevents the wound bed from drying into a hard crust. The type of dressing depends on the wound’s depth and how much fluid it produces.
Shallow, lightly draining wounds often do well with hydrocolloid dressings, which form a gel-like seal over the wound. Deeper wounds with more drainage may need foam dressings or alginate dressings (made from seaweed fiber), which absorb excess moisture while keeping the wound bed from drying out. For very deep wounds with tunneling or cavities, the wound may need to be loosely packed with a moist dressing material to prevent the surface from closing over before the deeper layers have healed.
Increase Protein and Calorie Intake
Healing a pressure injury is metabolically expensive. Your body needs extra protein to rebuild tissue and extra calories to fuel the process. Without adequate nutrition, even a well-managed wound will stall.
Guidelines recommend 1.25 to 1.5 grams of protein per kilogram of body weight per day for someone healing a pressure injury. For a 150-pound person, that works out to roughly 85 to 100 grams of protein daily, considerably more than most people eat. Total calorie intake should aim for about 30 to 35 calories per kilogram per day, with roughly one-third of those calories coming from fat and two-thirds from carbohydrates and protein.
Practically, this means adding protein-rich foods at every meal: eggs, dairy, meat, fish, beans, or protein supplements. Vitamins C and A, along with zinc, also play roles in tissue repair and immune function. If appetite is poor, small frequent meals or liquid nutrition supplements can help bridge the gap.
Watch for Signs of Infection
All open wounds carry infection risk, but pressure injuries are especially vulnerable because they occur in areas prone to contamination and in people whose immune systems may already be compromised. Catching an infection early prevents a manageable sore from becoming a dangerous one.
Local signs to watch for include increasing redness spreading outward from the wound edges, warmth around the site, swelling or hardening of surrounding tissue, increased pain, a change in the color or amount of drainage, and a foul smell. If the wound that had been improving suddenly stalls or gets worse, infection is a likely cause.
Systemic signs, like fever, chills, confusion, or a general sense of feeling unwell, suggest the infection may have spread beyond the wound itself. Deep sores that reach bone can develop bone infections, which are serious and require prolonged treatment.
When Surgery Becomes Necessary
Most Stage 1 and 2 sores heal with conservative care. Stage 3 and 4 sores, however, sometimes reach a point where the wound is too large or too deep to close on its own. When consistent wound care, nutrition, and pressure relief fail to produce progress over weeks to months, surgical closure may be the best option.
The most common surgical approach for deep pressure injuries is a flap procedure, where a surgeon moves a section of nearby muscle, skin, or both to cover the wound and provide a cushion of tissue over the underlying bone. Recovery from flap surgery requires weeks of strict pressure avoidance on the surgical site, and recurrence rates are significant if the underlying causes of pressure aren’t addressed long-term.