Commonly referred to as a sacral bed sore or decubitus ulcer.
Summary
A pressure ulcer is a localized injury to the skin and/or underlying tissue, typically over a bony prominence, as a result of prolonged pressure. A Stage 2 pressure ulcer involves partial-thickness skin loss with exposed dermis.
Causes
Prolonged pressure on the skin, especially over bony areas like the sacrum, due to immobility.
Friction and shear forces on the skin.
Poor circulation to the affected area, often secondary to immobility or tightly-fitted medical devices.
Risk Factors
Limited mobility due to confinement to a bed or wheelchair.
Advanced age, which often comes with softer or thinner skin.
Chronic conditions such as diabetes or vascular diseases that affect circulation.
Incontinence that results in moisture, increasing skin vulnerability.
Symptoms
Redness and soreness in the sacral area.
Partial-thickness skin loss looking like an open blister or abrasion.
Pain or tenderness in the affected area.
Diagnosis
Physical examination of the skin.
Assessment of skin color, texture, and integrity.
Staging of the ulcer based on visible tissue damage.
Treatment Options
Relieving pressure on the affected area by repositioning regularly.
Use of special mattresses or cushions to reduce pressure.
Wound care, including cleaning and bandaging, to promote healing and prevent infection.
Topical or systemic antibiotics if an infection is suspected.
Prognosis and Follow-Up
With appropriate care, Stage 2 ulcers can often heal within weeks.
Regular follow-up is crucial for evaluating healing progress and adjusting treatment for complications.
Complications
Infection which could lead to more severe health issues.
Worsening of the ulcer to stage 3 or 4, involving deeper tissues, muscle, or bone.
Chronic pain and reduced quality of life.
Lifestyle & Prevention
Regular repositioning to alleviate pressure points.
Maintaining good nutrition and hydration to improve skin health.
Keeping skin clean, dry, and moisturized to prevent irritation or breakdown.
When to Seek Professional Help
If you notice signs of infection, such as increased redness or pus.
If there is no improvement within a few days or if the ulcer appears to be worsening.
Sudden increase in pain or discomfort.
Additional Resources
National Pressure Ulcer Advisory Panel (NPUAP)
Wound, Ostomy and Continence Nurses Society (WOCN)
Websites like MedlinePlus or Mayo Clinic for further reading.
Tips for Medical Coders
Ensure accurate staging of the ulcer to apply the correct ICD code.
Document both location and stage clearly in the medical record.
Verify the ulcer’s cause is due to pressure; other types of ulcers have different codes.