Pressure injuries develop fast and worsen faster. If you're caring for a parent, partner, or family member with limited mobility, the difference between a stage 1 redness and a stage 4 wound exposing bone is often a matter of days, not weeks. This guide gives families a practical framework: how to recognize what stage you're looking at, what you can manage at home, and when to escalate to a wound specialist.
Key Takeaways
- Staging matters — knowing the difference between stage 1 and stage 3 changes what you do next and how urgent it is.
- Off-loading pressure is the single highest-impact intervention. No dressing replaces relieving pressure.
- Nutrition and hydration drive healing — protein, vitamin C, zinc, and water are not optional.
- Recognize complications early. Spreading redness, fever, foul odor, or sudden severe pain is a call-now situation.
- Nexcell sees patients two ways: by appointment at our Albuquerque clinic, and through our Surgeon-Led Bedside Teams at partnering skilled nursing facilities, LTACHs, and home-health agencies.
Understanding Pressure Injuries — The NPIAP Staging System
The National Pressure Injury Advisory Panel (NPIAP) uses a six-tier system. Knowing which one you're looking at tells you how urgent the situation is.
Stage 1. Intact skin with non-blanchable redness. Press gently — if the area stays red instead of turning white, the tissue underneath is already damaged. This is the earliest warning and the easiest stage to reverse.
Stage 2. Partial-thickness skin loss. You'll see a shallow open wound with a pink or red wound bed, or an intact / ruptured fluid-filled blister. The injury is now into the second layer of skin.
Stage 3. Full-thickness skin loss. Fat is visible in the wound. Slough (yellow stringy tissue) may be present. Tunneling — channels under the skin — can develop.
Stage 4. Full-thickness loss with exposed bone, tendon, or muscle. These wounds are deep, often have undermining or tunneling, and are at high risk for serious infection.
Unstageable. Full-thickness loss where the wound base is covered by slough or eschar (dry, dark, leathery tissue). The true depth can't be seen until that covering is removed by a clinician.
Deep Tissue Pressure Injury (DTPI). A localized area of persistent purple or maroon discoloration of intact or non-intact skin. The damage is happening in the deeper tissues first, and the surface may rapidly evolve into a stage 3 or 4 injury.
The Four Most Common Pressure Injury Sites
Sacrum (lower back, just above the tailbone). The single most common site for patients who spend time in bed. Body weight presses tissue against bone every minute the patient is on their back. Watch for redness here at every position change.
Heels. Heels have very little fat or muscle padding over bone, so blood supply to the skin gets cut off quickly. Float heels off the bed entirely with a pillow under the calves or with heel-protection boots — never let the heel rest on the mattress.
Ischial tuberosities (sitting bones). The most common site for patients who spend long hours in a wheelchair. Reposition more often when seated than when in bed — every hour at minimum.
Trochanters (outside of the hip). Affects patients who lie on their side for long periods. Use a wedge or pillow to tilt the body 30° rather than fully on the side, which puts direct pressure on the trochanter.
What You Can Do at Home — A Practical Caregiver Framework
This is the work that prevents most stage 1 and 2 injuries from progressing. Most of it costs nothing.
Reposition every 2 hours in bed, every 1 hour in a chair. Set a timer if you need to. Small shifts count — a 30° tilt with a pillow, lifting heels off the bed, repositioning a slumped patient back upright. Document the times in a notebook so multiple caregivers stay coordinated.
Use the right off-loading surfaces. Heel boots or a pillow under the calves to float the heels. Gel cushions or alternating-pressure mattresses for patients at moderate to high risk. Specialty mattresses are often covered by Medicare when criteria are met — ask the wound team.
Inspect skin every shift. Look at every bony prominence: sacrum, heels, hips, elbows, back of the head, ears (especially with oxygen tubing). Any new redness gets off-loaded immediately and re-checked in 30 minutes.
Manage moisture. Incontinence-associated dermatitis weakens skin and accelerates breakdown. Clean promptly with a pH-balanced cleanser, pat dry, and use a barrier cream or moisture-barrier ointment. Avoid harsh soaps.
Feed for healing. Aim for 1.2–1.5 grams of protein per kilogram of body weight per day. Make sure your loved one is hydrated. Vitamin C and zinc support tissue repair. If your family member is losing weight or eating poorly, ask about a referral to a registered dietitian — this is one of the most underused interventions in wound care.
Dressing basics. Keep the wound covered. The healing environment should be moist, not wet. Foam dressings are a reasonable default for stage 2 and many stage 3 wounds, but the right dressing depends on drainage, depth, and bacterial burden — your wound team will guide this.
What NOT to do. No heat lamps. No doughnut-shaped cushions (they cut off circulation in a ring around the wound). No hydrogen peroxide or betadine for routine wound care — both damage the healthy cells needed to heal. No massaging a red area — it can worsen tissue damage underneath.
Recognizing Complications — When to Act Fast
These signs mean the wound has moved past what home care can safely manage:
- Redness that spreads beyond the wound edge
- New fever or chills
- Foul or rotten odor
- Drainage that suddenly increases in volume or changes color
- Exposed bone, tendon, or hardware
- Sudden severe pain — especially out of proportion to the wound
- New confusion in an elderly patient (often the first sign of sepsis)
Hard rule: signs of sepsis — high fever, rapid heart rate, low blood pressure, confusion, rapidly spreading redness — mean call 911. Do not wait to call the clinic.
Two Ways Nexcell Helps Families Manage Pressure Injuries
We deliver the same surgeon-led wound care in two settings.
Track 1 — Appointments at our Albuquerque clinic. By appointment at 3901 Georgia St NE Suite C4. Self-referral welcome — no provider referral required. Most major insurance accepted, including Medicare and Medicare Advantage. New patients are usually seen within a week. You'll work with the same surgeon and wound nurse across visits, and we'll coordinate with your loved one's primary care, home-health agency, and any specialists already involved.
Track 2 — Surgeon-Led Bedside Teams. If your loved one lives in a partnering skilled nursing facility, long-term acute care hospital, or is followed by a home-health agency that works with us, our Surgeon-Led Bedside Teams round at bedside on a defined cadence. A Nexcell surgeon and wound nurse evaluate the wound in place, debride when appropriate, write the plan, and adjust it weekly — no transfer to clinic required.
In our published outcomes data, this model achieved a mean time to wound closure of 47.5 days vs 69 days under usual care (PubMed 31461401). Results vary by patient and wound type.
When to Call Nexcell vs When to Call 911
Call Nexcell at 505-624-8340 if: you see a stage 2 or higher pressure injury, redness that hasn't blanched after 24 hours of off-loading, drainage that is increasing, a wound that hasn't progressed in 1–2 weeks, or signs of infection without sepsis (mild warmth, slightly increased drainage, low-grade fever).
Call 911 or go to the ER if: there is a high fever, rapidly spreading redness, red streaks moving away from the wound, severe pain, new confusion, a sudden drop in blood pressure, or exposed bone with new severe pain.
When in doubt, err toward calling. We'd rather hear from you for a wound that turns out to be fine than learn about it after a hospital admission.