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Stage 3 pressure injury - Pressure Ulcer Staging
Other Resources UpToDate PubMed

Stage 3 pressure injury - Pressure Ulcer Staging

Contributors: Ansa Ahmed MD, Sally-Ann Whelan MS, NP, CWOCN, Lisa Wallin ANP, FCCWS, Art Papier MD
Other Resources UpToDate PubMed


A stage 3 pressure injury has full thickness loss of skin with the epidermis and dermis both destroyed. There is damage to and necrosis of subcutaneous tissue. Damage extends down to but not through the underlying fascia. Subcutaneous fat may be visible, but the ulcer does not extend deep enough to expose tendon, muscle, or bone. There may be slough or necrotic tissue or eschar present, but the base of the ulcer is still visible. A stage 3 pressure injury may also appear clean looking without any necrosis. There may also be some element of undermining or tunneling.

Typical sites of formation of a stage 3 pressure injury are the sacrum followed by the heels. A primary cause of pressure injury formation is immobility. Constant pressure for a time period of 2 hours is all that is required to initiate an ischemic event and to cause ulceration.

Other risk factors that predispose to ulcer formation include incontinence, nutritional deficits, old age, altered mental status, and malnutrition.

When examining the ulcer, observe the following specific points:
  • Location on the body
  • Stage of the ulcer
  • Size of the ulcer, including depth, width, and length in centimeters.
  • Wound bed – Appearance of the wound bed and the type of tissue visible. Observe the tissue color and whether it appears moist. The wound bed color of healthy granulating tissue is beefy-red and cobblestone-like. A red and smooth wound bed is indicative of clean but nongranulating tissue.
  • Wound edges – Look carefully at the edge of the ulcer for evidence of induration, maceration, rolling edges, and redness.
  • Skin around the edges of the ulcer – The periwound skin should be assessed for color, texture, temperature, and integrity of the surrounding skin.
  • Drainage; exudate – If present, the color, amount, and presence of any odor.
  • Presence of undermining, tunneling, or sinus tracts. Tunneling is a passage that extends from the wound through to subcutaneous tissue or muscle. Undermining is the destruction of tissue around the edge of that wound.
  • Presence of necrotic tissue
  • Presence or absence of pain
  • Odor, if present or absent
The National Pressure Ulcer Advisory Panel 2016 updated staging system also includes the following:
  • Medical device-related pressure injury (describes an etiology) – Results from the use of devices designed and applied for therapeutic purposes. Injury generally conforms to the pattern or shape of the device. Stage using the staging system.
  • Mucosal membrane pressure injury – Found on mucous membranes with a history of a medical device in use at the location of the injury. Cannot be staged due to anatomy of tissue.
Related topic: Pressure Injury (overview)


L89.93 – Pressure ulcer of unspecified site, stage 3

1163222004 – Pressure injury stage III

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Last Updated:07/19/2018
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Stage 3 pressure injury - Pressure Ulcer Staging
A medical illustration showing key findings of Stage 3 pressure injury : Buttocks, Heel, Occipital scalp, Sacral region of back, Skin ulcer, Bedridden patient
Clinical image of Stage 3 pressure injury - imageId=2845449. Click to open in gallery.  caption: 'Stage 3 pressure injury showing clean, small ulcers, each with a violaceous border, on the upper buttocks.'
Stage 3 pressure injury showing clean, small ulcers, each with a violaceous border, on the upper buttocks.
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