Pressure ulcers: surgery. To deliver nursing care and prevent the development of pressure ulcers, it is essential to identify the factors that affect it. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Apr 16, 2017 - Explore Felicia Richardson's board "Pressure ulcer staging", followed by 109 people on Pinterest. Stage 2: Your skin is bubbling and blistering. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Stage I – A Stage I decubitus ulcers usually appears as a red spot on the skin that fails to disappear once the pressure from the area is relieved. Pressure ulcers are categorized into four stages: 1. The wound is superficial with partial-thickness skin loss. This cookie is set by GDPR Cookie Consent plugin. The sore is extremely deep and now has reached into the bone and muscle cause extreme damage. Bed sores can form in any area of the body where pressure builds and remains unrelieved. The skin may not be broken at first, but if the pressure ulcer gets worse, it can form: an open wound or blister – a category 2 pressure ulcer; a deep wound that reaches … Color changes do not include purple or maroon discoloration which may be an indication of deep tissue injury. 31-3), also referred to as decubitus, decubitus ulcers, pressure sores, or “bed-sores,” are the most common wound class in patients with advanced cancer, occurring in 22.4% of patients, and having an incidence rate of 22.4 new wounds per month per 100 patients. Pressure ulcers Staging pathogenesis and clinical manifestations. Adam has many years of research in public data, and software security. Search for anything within the text, and have the results presented on screen in a few seconds. Unrivalled as the comprehensive, modern guide to all recognised Dermatological Diseases. This is true for anyone that sits for prolonged periods in chairs, wheelchairs, or beds. Description and identification of pressure ulcers. Pressure Ulcer Staging Stage 1: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. This guide was developed as a reference tool for clinicians caring for patients who are at risk for or who have pressure ulcers and other commonly encountered chronic wounds. Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! We are able to provide these free guides because we are supported by affiliate commissions. WOUND ASSESSMENT CHECKLIST • Location • Stage • Size • Pressure Redistribution • Dressing Used • Nutritional Assessment • Drainage (Amount/Color/Odor) • Viable Tissue in Wound • Undermining/Tunneling A stage I pressure ulcer has redness … The 4 main factors implicated are interface pressure, shear, friction, and moisture. This is medical illustration. WoundEducators.com | Online Wound Care Certification Courses. Found insideYear after year, this text is recommended as the primary preparatory resource for the Geriatric Physical Therapy Specialization exam. And this new fourth edition only gets better. These stages include: Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. A series of slides of pressure ulcers (bedsores) at various stages. Full-thickness loss of skin, in which fat may be visible in the injury and granulation tissue, and rolled wound edges (epibole) are often present. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Stage IV Pressure Ulcer: Full thickness tissue loss with exposed bone, tendon or muscle. Best Manual Wheelchairs (2021 In-Depth Review For Buyers), Best Heavy-Duty Manual Wheelchairs in 2021, Best Reclining Manual Wheelchairs (High Back & Tilt-in-Space), Best Power Wheelchair For Outdoor Use (We Rank The Best In 2021), Best Mobility Scooters Buying Guide (Choose The Best One), Best Heavy Duty Mobility Scooters in 2021, Pride Mobility Scooters (In-depth Review), Best Walkers For Seniors (Top Recommendations & Reviews), Best Pediatric walkers & Gait Trainers for Kids in 2021, Best Beach Walkers (What Walkers Work Best In Sand). Pressure Ulcer Stages 1, 2, 3 and 4. Free Materials. Reddy M, Gill SS, Kalkar SR, et al. She has been actively involved with the Wound, Ostomy, Continence Society and has many years of service on the board of directors for the Association for the Advancement of Wound Care, and the American Board of Wound Management of which she also served as President. A stage 2 ulcer is a partial thickness wound. Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the injury. Full thickness skin, muscle loss with slough and/or eschar present in the base of the pressure ulcer, preventing you to see the true depth of the ulcer. All major credit cards & PayPal accepted. Stage 3: full thickness ulcer that might involve the subcutaneous fat. Stages 1, 3, and 4 made up about the other 50% of all ulcers. Similar to measurements of burn severity, each stage of pressure ulcer severity indicates a different depth and a new layer of tissue affected. • The area may be painful, firm or soft and warmer or cooler when compared to surrounding tissue. Pressure ulcers stage I through III can be managed with aggressive local wound treatment and proper nutritional support while stage IV pressure ulcers usually require … www.npuap.org. This would consist of wheelchairs, canes, walkers, and more to gain back the independence of moving. When pressure is put on the spot the flow of blood that occurs through the skin gets disrupted. Her broad experience from bedside to innovation and industry has provided a unique perspective that she has shared as a consultant and educator. undermining and tunneling often present. Pressure sores that do not fit into a stage. Guidelines for Staging of Pressure Injuries* *National Pressure Ulcer Advisory Panel (NPUAP) – Accessed April 2016. A stage I pressure ulcer has redness on the surface of the skin that does not disappear when pressure is relieved. The Edit • Print • Download • Embed • Share. JeopardyLabs. These cookies will be stored in your browser only with your consent. Stage 1. Fat may show in the sore, but not muscle, tendon, or bone. Support Our “Where There’s a Wound, There’s a Way!™” Foundation. These cookies ensure basic functionalities and security features of the website, anonymously. When this happens it can lead to ulcer forming. Bedsores are also referred to as: pressure injuries, decubitus ulcers, pressure sores or pressure ulcers.The risks associated with bedsores, various stages involved, preventive measures, home remedies and treatment plans, are well discussed ... No teams 1 team 2 teams 3 teams 4 teams 5 teams 6 teams 7 teams 8 teams 9 teams 10 teams Custom. L89.222 Pressure ulcer of left hip, stage 2. The stages are based on how deep the sores are. Stage IV pressure ulcers were the most prevalent (Table 1). If the pressure ulcer is healed completely, a code is not reported for the pressure ulcer. Do not reverse stage when documenting a healing pressure injury/ulcer. Because of this, there are a few things you can do to minimize getting pressure ulcers. Stage I: • Intact skin with localized, non-blanchable erythema over a bony prominence. See pressure ulcer stock video clips. Pressure ulcers come in 4 stages. As a result all stages of pressure ulcers are included in the numerator for data prior to October 1, 2009]. This Quick Reference Guide is intended for busy health professionals who require a quick reference in caring for individuals in the clinical setting. Users should not rely on excerpts from the Quick Reference Guide alone. Treatment of pressure ulcers: a systematic review. The cookie is used to store the user consent for the cookies in the category "Analytics". What is a pressure ulcer? This comprehensive yet concise wound care handbook covers all aspects of wound care: wound healing, wound assessment, and treatment options for all types of wounds. The above image demonstrates a category IV pressure injury, meaning that full-thickness skin and tissue loss has occurred. The purpose of this study was to determine if an article and the National Pressure Ulcer Advisory Panel Staging Guide was sufficient education for nurses to accurately stage pressure ulcers (PU). Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. This is when the sore or ulcer extends into the tissue beyond the skin. JAMA 2008; 300:2647. Treatment 4. This ulcer occurs in four stages: Stage I - There is no broken skin but it will look discolored and red. The bridge of nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Photos are the only way to appreciate the devastating impact on the individual. Table 2 presents the National Pressure Ulcer Advisory Panel's staging system for pressure ulcers.16 In a person with dark skin pigmentation, a stage I ulcer may appear as a … Epibole, undermining and tunneling often occur. At stage 2 pressure ulcers the skin now breaks open, forms an ulcer, or wears away. This site uses Akismet to reduce spam. Adv Wound Care 1998; 8:32. NPUAP Pressure Injury Stages The updated staging system includes the following definitions: Pressure Injury: A pressure injury is localized damage to the skin … Bedsores are ulcers that happen on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, or wearing a cast for a prolonged time. In stage IV pressure ulcers, these may be apparent at the base of the ulcer. For each pressure ulcer present, the stage is described and it is determined whether the ulcer was present on admission. Based on the Agency for Healthcare Policy and Research (AHCPR.) Clinical Practice Guideline Pressure Ulcers in Adults: Prediction and Prevention, this program defines the four stages of pressure ulcer development, uses assessment tools to ... Make sure you describe your assessment findings, including: injury/ulcer location, size (measured length, width and depth), tissue type(s), color, wound edges, any sinus tracts, undermining or tunneling, exudate (amount, type and odor) and periwound assessment of skin heat, tenderness, change in consistency or pain. Duration and intensity of pressure are crucial to the development of pressure ulcers; low-intensity pressure of long duration can be as damaging to tissues as high-intensity pressure experienced for a briefer period of time. You might hear medical and Pressure sores can form and develop when a large amount of pressure is put on the area of the skin over a short period of time. This cookie is set by GDPR Cookie Consent plugin. Sanara MedTech Inc. Susan has 30+ years of clinical experience across the continuum of care. When treating pressure ulcers you can expect the use of creams, gels, and dressings that are designed to help and speed up the healing process. It is possible that you can even have damage to joints, tendons, and tissue that is deeper. This is a pilot study that is currently ongoing with positive implications. An increase in blood flow and leukocyte migration has been linked to healing. The stages of pressure ulcer are indicative of the amount of tissue damage. There are various stages of pressure injury, all of which classify the injury based on the depth of skin injury. In addition, pressure ulcer treatment typically involves multiple treatment modalities at once (e.g., support surface plus dressings plus nutritional supplementation), and often different treatments are applied at different stages of treatment. These pressure sores only affect the upper layer of your skin. Rev. ed. of: Acute and chronic wounds / [edited by] Ruth A. Bryant, Denise P. Nix. 3rd ed. c2007. This cookie is set by GDPR Cookie Consent plugin. When a wheelchair user sits in the same spot without moving and adjusting their position can cause pressure to build in the skin causing a sore to develop. Pain and temperature change often precede skin color changes. Meaning, if the pressure ulcer was to the bone (stage 4) but improves during the stay to only include the depth of the subcutaneous tissue (stage 3), the pressure … May look like a mild … In addition to direct pressure, shear may also contribute to pressure injury development. Try these curated collections. Stage 2: erythema with the loss of partial thickness of the skin including epidermis and part of the superficial dermis. Due to the anatomy of the tissue these ulcers cannot be staged. Without the proper blood flow, the skin loses its oxygen and starts to break down. full-thickness tissue loss with exposed bone, tendon, or muscle. The new F-tag 314: prevention and management of pressure ulcers. The pressure injury/ulcer staging classification system is developed specifically to describe pressure impact on the skin and surrounding tissue, and cannot be used to categorize other wound etiologies. The cookies is used to store the user consent for the cookies in the category "Necessary". Common questions about pressure ulcers. Darkly pigmented skin may not have … Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Description and identification of pressure ulcers. Found inside – Page 12The inclusion of stage 1 pressure ulcers, defined as non-blancheable discolouration of the skin, in the overall classification of pressure ulcers is an important explanation for the differences found in the literature for both ... Found inside – Page 19The staging was proposed by Shea in 1975 [1] and the Wound Ostomy Society (International Association of Enterostomal Therapy) in 1988, and was finally agreed upon in 1989 by the National Pressure Ulcer Advisory Panel, United States. Meaning, if the pressure ulcer was to the bone (stage 4) but improves during the stay to only include the depth of the subcutaneous tissue (stage 3), the pressure ulcer is to be reported as a stage 4 pressure ulcer, not a stage 3. Background: Decubitus ulcers are soft tissue injuries formed from prolonged pressure on the skin. For discharges prior to this date, only pressure ulcer diagnosis codes 707.0x are required for inclusion in the numerator. It is the first sign that your skin and tissue are starting to break down and may worsen. Stage 1 Pressure Sores and Ulcers: Early on in pressure ulcer development, the skin is developing injury. This report systematically reviews the evidence on (1) risk-assessment scales for identifying people at higher risk of pressure ulcers and (2) preventive interventions to decrease incidence or severity of pressure ulcers. infection. Background Fast Fact #40 discussed the staging and prevention of pressure ulcers; this Fast Fact discusses their management. The earlier a pressure ulcer is noticed, the easier it usually is to treat. Raetz J, et al. Unstageable Wounds (A Pressure Ulcer Stage) Estimated reading time: 1 min. Several images show nude buttocks. Letting these sores go can cause longe treatment to heal and much more pain and discomfort. Using the easy to read, quick-access Fast Facts style, the book presents guidelines for assessing, preventing and treating pressure ulcers; for establishing an ulcer reduction program and for increasing reimbursement. (Medical & Surgical) Pressure ulcers are more likely to appear over pressure points such as heels, tips of toes, between toes, or anywhere the bones may protrude and rub against socks, shoes, or bed sheets. Adv Wound Care 1998; 8:32. Necrotic or sloughy pressure ulcers should be debrided to promote healing and to enable the stage of the ulcer to be assessed accurately. Fat (adipose) and deeper tissues are not visible. The pressure ulcer staging system should not be used to describe other types of wounds, such as neuropathic foot ulcers, epidermal stripping, surgical wounds, or … •The depth of a Stage 4 pressure ulcer varies by anatomical location. The depth of a Stage 4 pressure injury varies by anatomical location. A mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury and due to the anatomy of the tissue, these injuries cannot be staged. This book provides an up-to-date scientific account of all aspects related to pressure ulcers and pressure ulcer research, as well as evidence-based knowledge of pressure ulcer aetiology. The skin temperature is also warmer than the surrounding areas. Those with a large body mass may exhibit deep wounds. All transactions are performed via a SSL secure server to ensure your privacy. This now causes more pain than stage 1. When this happens it will be for small carters. The International Classification System represents international consensus (NPIAP, the European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance) on the classification of pressure injuries/ulcers. Pressure injury that results from the use of devices designed and applied for diagnostic or therapeutic purposes. In this thoroughly updated edition, readers learn the full scope of the pressure ulcer problem to deliver quality care and educate patients and their families more expertly. © 2021 All Rights Reserved. The pressure ulcers on the buttocks are documented as full thickness skin loss with necrosis into the subcutaneous tissue. The recommended treatment program focuses on assessment of the patient and the pressure ulcer: tissue load management; ulcer care; management of bacterial colonization and infection; operative repair in selected patients with Stage III and ... A pressure ulcer is a sore, an area of skin that has been damaged due to unrelieved and prolonged pressure. stage four. One being the mildest and four being the worst. Can anyone refer information on billing and reimbursement for wound care as an APN? There are stages of pressure ulcers that range from stages one to four. Stage 4 wounds … It no longer has healthy blood … It does not describe healing tissue. Press F11. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. Guidance and insights on managing the single most expensive nursing diagnosis. Thanks. In some severe cases, there are two kinds of pressure ulcers that cannot fit into one of the four stages: suspected deep pressure injury unstageable sores The same outcome will hold true when light pressure is applied over longer periods of time. The amount of tissue damaged remains the same, and granulation tissue is not the same as the original tissue. Pressure Ulcer Stages 1, 2, 3 and 4. For the decubitus (or lying down) patient, the points under most prolonged pressure involve the tissue between any bony prominence and the patient's bed. The injury may present as intact skin or an open ulcer and may be painful. You will see skin that is red in color and when you press your finger on it and then remove your finger from the area it does not lose color. Interested in learning more about wound care and certification? This text provides an essential resource in effective and efficient wound-care management. The Care of Wounds has been written based on current research and drawing upon the author's wide experience in the field of tissue viability. Full-thickness skin and tissue loss in which the extent of tissue damage within the injury cannot be confirmed because it is obscured by slough or eschar. Ⓒ 2021 MobilityMedicalSupply All Rights Reserved. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. For example, “healing stage 4 pressure injury with granulation tissue over x% of the wound bed,” or another example might be a “fully epithelialized (or closed) stage 3 pressure injury.”. { Stage 1 or 2 pressure ulcers { Skin tears { Moisture associated skin damage (MASD) of the incontinence-associated dermatitis (IAD) type { Contact dermatitis { … ... Black, J. M., Goldberg, M. … https://www.woundsource.com/patientcondition/pressure-ulcers-stages-3-and-4 For more information on products indicated for the treatment of pressure injuries, please visit https://sanaramedtech.com/wound-care/, 1200 Summit Avenue, Suite 414 Fort Worth, TX 76102 | (817) 529-2300. Stage IV – A stage IV … Stages of pressure ulcers Pressure ulcers are grouped into four stages, depending on how deep the ulcer is. 2020 World Wide Pressure Injury Prevention Day. The discoloration may vary from blue to purple. Pressure sores, pressure ulcers, or bedsores happen when you sit or lie in the same position for too long and the weight of your body cut off blood supply to that area. Part 2 offers profiles and photos of hundreds of skin and wound care products, all categorized and alphabetized for easy reference. The book also includes a full-color wound photo section, wound checklists, and much more. Stage IV is the worst. Your online source for wound care certification. NPIAP Pressure Injury Stages. NPUAP position on reverse staging of pressure ulcers. The cookie is used to store the user consent for the cookies in the category "Performance". This can be called a deep tissue injury or (DTI). Notes Definition. Resources For Faculty. It describes and classifies localized injury to the skin and/or underlying tissue, as well as the categories of unstageable and suspected deep tissue injuries that describe pressure injuries for which the full extent of damage to the tissue and skin remains unknown. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Stage 2 was the most common (5%), accounting for about 50% of all pressure ulcers. (i.e.- a Stage 4 pressure injury cannot become a Stage 3, Stage 2, and/or This medical reference book boasts an intuitive and easy to use format that covers the full spectrum of options, equipping you with not only standard treatment strategies, but second- and third-line therapies for instances when other ... Browse 259 pressure ulcer stock photos and images available, or search for ulcer or senior in bed to find more great stock photos and pictures. Intact or non-intact skin with localized area of persistent non-blanchable deep, red, maroon, purple discoloration or epidermal separation, revealing a dark wound bed or blood-filled blister. Category L89 contains combination codes to identify the site, laterality and pressure ulcer stages. I Completed My Wound Care Course – Now What? pressure ulcer … She is currently vice-chair for the American Board of Wound Management Foundation. An area of skin that feels cooler or warmer to the touch than other areas Pressure ulcers (Fig. At this point, you can expect to see fat in the sore. The Four Stages Pressure ulcers are staged based on the amount of skin and tissue damage:2 Stage 1: Your skin has persistent redness . The depth of a stage IV pressure ulcer varies by anatomical location. Home » Caregiving » Stages Of Pressure Ulcers. Stage One. The resultant pressure injury generally conforms to the pattern or shape of the device. Slough or eschar may be present on some parts of the wound bed. The National Pressure Ulcer Advisory Panel has redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers. Stage I decubitus ulcers can usually be eliminated with proper treatment and turning by the healthcare provider. & ;This guide was developed as a basic reference tool for clinicians caring for patients who are at risk for or who have pressure ulcers. Illustrations depict typical examples encountered in clinical practice. How Do People In Wheelchairs prevent Pressure Sores? Depth varies by anatomical location. Other factors that may impact the development of a pressure injury include changes in microclimate, nutrition, perfusion, co-morbid conditions and condition of the soft tissues. Pressure ulcers can be painful and challenging to get control over if not treated early on. Found inside – Page 200Pressure ulcer staging The most widely used system for staging pressure ulcers is the classification system developed by the National Pressure Ulcer Advisory Panel ( NPUAP ) . This staging system , which defines four stages , has been ... The cookie is used to store the user consent for the cookies in the category "Other. National Pressure Ulcer Advisory Panel. Pressure ulcers grade 1 to 3 (stages I to III) usually do not have surgically removed become. L89.313 Pressure ulcer of right buttock, stage 3 L89.323 Pressure ulcer of left buttock, stage 3 L89.012 Pressure ulcer of right elbow, stage 2 L89.022 Pressure ulcer of left elbow, stage 2 pressure ulcers on air-fluidized surfaces had statistically significant faster healing rates (particularly for stage III and stage IV ulcers) compared with patients on low air-loss and replacement mattresses. – The … Stage I: A reddened, painful area on the skin that does not … According to Sullivan and Schoelles (2013), pressure ulcers occur in four stages. Do not Reverse Stage: NPUAP pressure injury staging describes the depth of tissue damage due to pressure. of 13. pressure sore bed sores pressure sores ulcer on the skin presure ulcer bed sore graves disease bed sore wound bed ulcers applying a dressing to a wound. Slough and/or eschar may be visible. Of recommendations -- Interpretation of evidence -- Responsiblity for guideline development -- Purpose and scope -- Original development process - 2002 -- Revision process - 2006/2007 -- Definition of terms -- Background context -- Practice ... pressure ulcer: an ulcer due to local interference with circulation; persons most at risk are those who are emaciated (nutritionally deficient in protein), obese, immobilized by traction or anything else, diabetic, or suffering from a circulatory disorder. As a result, they are still quite graphic. Learn how your comment data is processed. Slough may be present, but does not obscure the depth of tissue loss. 2015;92:888. Stage I is the mildest stage. The depth of tissue damage varies by anatomical location. It can result from intense and/or prolonged pressure that is significant enough to compromise tissue circulation. Features patient information on pressure ulcers, or bedsores, which are caused by consistent pressure on the same area of skin. Discusses the stages of pressure ulcers and treatment, provided online by Health-Center, Inc. Pressure ulcer prevalence varied by age, sex, and length of time since admission to the nursing home, but not by race. Thomas DR. Stage four pressure ulcers appear as deep pockets, and the client is at increased risk of acquiring a wound-related infection. This approach allows the determination … Patients had an average of nearly four (median = 3) ulcers each (Table 2). Found inside – Page 135The definitions for the stages of pressure ulcers identified below, are from the NPUAP and used with permission.34 “Stage I”– □ An observable, pressure-related alteration of intact skin, whose indicators as compared to an adjacent or ... Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more, Copyright © 2009-2021 WoundEducators.com Wound Care Certification Courses | Risk Free Guarantee | Terms and Policies. MobilityMedicalSupply is a free resource that offers in-depth guides on medical equipment and products to assist and help with mobility issues. Symptoms: … You will feel warm to the touch and may be itchy. And the stage 1 sore can feel either firmer or softer than the area around it. (Wheelchair Insurance Coverage), There are times when a deep pressure injury cannot be confirmed. NPUAP position on reverse staging of pressure ulcers. The wound may evolve rapidly to reveal the actual extent of tissue injury or may resolve without tissue loss. Stage 4 pressure injuries can extend into muscle and/or supporting structures (e.g. Chronic foot ulcers affect elderly the most, we have designed the Life/form® Elderly Pressure Ulcer Foot for instruction on care and cleaning of pressure ulcers in various stages. Stages of pressure sores STAGE 1. It is the wish of all multidisciplinary experts who gather prominent author's panel of this volume to incorporate latest medical reports and compel limits of current understanding for better tissue regeneration, limb salvage, and improved ... of six pressure ulcer stages.1,2 The goal of this revi-sion was to increase the number of correctly staged pressure ulcers.1 In June 2008, the Pennsylvania Patient Safety Authority incorporated this change in its reporting system for skin integrity/pressure ulcer stages. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. Getting Started: Wound Care Certification. for full-screen mode. One being the least dangerous to four being the worst. There are a number of stages of pressure ulcers defined by the National Pressure Ulcer Advisory Panel. Need Customer Service? Stage III pressure ulcers may include undermining and tunneling.

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