By Nursing Home Law Center
Just as it sounds, a ‘deep tissue injury’ is an injury to a patients underlying tissue below the skin’s surface that results from prolonged pressure in an area of the body. Similar to a pressure sore, a deep tissue injury restricts blood flow in the tissue causing the tissue to die. While the mechanics of a DTI may be slightly different that a pressure sore in that injury occurs to deeper tissues as opposed to superficial skin commonly associated with pressure sores, the resulting condition can be just as painful, debilitating — and even deadly.
According to the National Pressure Ulcer Advisory Panel (NPUAP), the leading authority on pressure ulcer research and information, a “deep tissue injury’ (DTI) as ‘a purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear”.
The NPUAP goes on to describe the progression of the injury as:
The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue. DTI many be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid, exposing additional layers of tissue even with optimal treatment.
A DTI can occur in a hospital, nursing home or any setting where a patient is left on a hard surface for an extended period. However, some of the group most prone to develop DTI’s are patients receiving acute-care in a hospital or those undergoing lengthy surgery. For this reason it is not uncommon for medical facilities to claim the DTI’s are unavoidable and simply part of the medical process.
In some cases the extent of the DTI may not be known until the patient has been discharged from the facility to a rehabilitation center or home due to the fact that the overlying skin may remain intact for 10-14 days following the initial deep tissue injury.
If you believe a family member has suffered a deep tissue injury during an admission to a hospital or nursing home, be sure to obtain medical attention as soon as the injury become apparent. In many cases, it can be helpful to take photos of the area after there is an indication of a deep tissue injury to preserve your future legal rights.
Are All Pressure Ulcers the Result of Deep Tissue Injury? A Review of the Literature, Ostomy and Wound Management, VOLUME: 53 Issue Number: 10 authored by, Dan R. Berlowitz, MD, MPH; and David M. Brienza, PhD
Hypoxia is Involved in Deep Tissue Injury Formation in a Rat Model, Wounds, February 1, 2010 by Yunita Sari, MHS; Takashi Nagase, MD, PhD; Takeo Minematsu, PhD; Tomoko Akase, RN, RPh, PhD; Gojiro Nakagami, RN, PhD; Hiromi Sanada, RN, WOCN, PhD; Junko Sugama, RN, PhD
Pressure Ulcers: What Clinicians Need to Know, The Permanente Journal Summer 2010 – Volume 14 Number 2 by William T Wake, MD, FAAFP
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