A pressure ulcer or decubital ulcer is localized injury to the

skin and/or underlying tissue usually over a bony prominence,

as a result of pressure, or pressure in combination with shear

Etiology and pathogenesis

Pressure or force per unit area is considered to be the most important factor in pressure
ulcer formation. Normal tissue pressure is between 12 to 32 mmHg. Pressure higher
than this upper limit can compromise tissue circulation and oxygenation. When patien
lies immobile on a hospital bed, pressures as high as 150 mmHg can be generated.
Especially over bony prominence. Constant pressure can lead to tissue death
Shear force results from the motion of bone and subcutaneous tissue relative to the
skin when the skin is fixed. Shearing forces are parallel to the tissue surface, and the
subsequent sliding pressure is transmitted to deeper tissues, which can become
angulated and occlude the blood vessels

Friction can cause damage to the superficial layers of the skin

A moist environtment from urinary incontinence, perspiration, or excessive wound
drainage can cause maceration of the skin, which increases the risk of pressure ulcer
formation