Pressure ulcers, commonly known as bedsores, are injuries to the skin and underlying tissue resulting from prolonged pressure or friction, often occurring in individuals with limited mobility. These injuries are classified into stages based on the depth of tissue damage. A Stage 3 pressure ulcer involves full-thickness skin loss, requiring highly specialized wound care management. Choosing the correct dressing is a dynamic process that directly influences healing and prevents further complications.
Understanding the Clinical Characteristics of a Stage 3 Pressure Ulcer
A Stage 3 pressure ulcer is defined by full-thickness skin loss, meaning the injury extends completely through the epidermis and dermis layers of the skin. This depth of injury often exposes the underlying subcutaneous fat tissue, which may be visible within the wound base. The ulcer often presents as a deep, crater-like wound, and the edges may appear “rolled” or curved inward, a condition known as epibole.
While subcutaneous fat is visible, bone, tendon, ligament, or muscle are not exposed. If these deeper structures were visible, the injury would be classified as a Stage 4 ulcer. The wound bed may contain slough (yellow or gray non-viable tissue) or eschar (dark, hard necrotic tissue). Tunneling or undermining, narrow passages extending from the wound, can also be common, making the true extent of tissue damage greater than what is visible on the surface.
Primary Goals of Wound Management at Stage 3
Successful treatment relies on meeting three fundamental objectives to prepare the wound bed for healing. The first is debridement, which involves removing non-viable tissue like slough and eschar. Necrotic tissue harbors bacteria and obstructs the formation of healthy granulation tissue, making its removal necessary for wound progression.
A second goal is exudate management, as Stage 3 ulcers often produce moderate to heavy drainage. This fluid must be absorbed effectively to prevent pooling and maceration (softening and breakdown of surrounding skin). The final objective is to maintain a moist wound environment. A slightly moist surface promotes cell migration and proliferation, essential processes for the growth of new tissue and wound closure.
The dressing selected must contribute to these objectives simultaneously. The treatment plan is dynamic, requiring the dressing to be changed as the wound bed condition evolves from one phase to the next.
Recommended Dressing Categories and Their Functions
The selection of a dressing for a Stage 3 pressure ulcer is highly specific to the wound’s presentation, including the amount of exudate and the presence of non-viable tissue.
Specific Dressing Types
- Foam Dressings: Frequently used for wounds with moderate to heavy exudate because they possess a high fluid absorption capacity. Made of polyurethane, they also provide a cushioning effect, which helps protect the delicate wound site from external pressure and trauma.
- Alginates and Hydrofibers: Preferred for deeper ulcers producing heavy exudate due to their exceptional absorbency. These materials wick fluid away and transform into a soft, cohesive gel upon contact. This gelling action manages drainage and conforms to the wound bed, making them ideal for packing deep, irregular ulcers that may have undermining or tunneling.
- Hydrogels: Applied to wounds with dry slough or eschar to facilitate autolytic debridement. These water-based or glycerin-based dressings donate moisture to the wound bed, which softens the necrotic tissue, allowing the body’s own enzymes to break it down naturally. A hydrogel requires a secondary, more absorptive dressing, such as a foam, to cover it and manage any resulting exudate.
- Hydrocolloid Dressings: Considered for Stage 3 ulcers with minimal-to-moderate exudate, as they form a gel that helps maintain a moist environment. They are useful for promoting autolytic debridement of wounds with small amounts of slough. However, they are avoided on heavily draining or infected wounds due to their occlusive nature.
- Antimicrobial Dressings (Silver): Incorporated when infection is a concern. These specialized dressings contain silver or other antimicrobial agents and are often used as the primary layer under a highly absorbent secondary dressing (like a foam or hydrofiber) to help maintain a balanced microbial environment while managing heavy drainage.
Continuous assessment is necessary to match the dressing’s function with the immediate needs of the healing tissue.