Deep tissue injury
- Purple or maroon localised area, an area of discoloured intact skin, or a blood filled blister.
- Deep tissue injury (DTI) is due to damage to the underlying soft tissue from pressure and/or shear forces.
- The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
- DTI may be more difficult to visually detect in people with darker skin tone. Gently palpate suspected areas.
- Evolution may include a thick blister over a dark wound bed. The PI may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.
Image credit: Reproduced with permission of Wounds Australia. All rights reserved.
Spinal Tip
Tertiary referral is recommended for people with Deep Tissue Injury (DTI)
DTI may occur before any damage to superficial tissue (Houghton et al 2013).
Obesity can increase the risk of deep tissue injury after SCI, possibly due to increased internal stress / forces combined with muscle atrophy (Elsner and Gefen 2008) and vascular compromise.
Consider ultrasound imaging of the tissue overlying the ischial tuberosity (IT) to identify potential deep tissue injury (Canadian Best Practice Guidelines Recommendation 1.7 Level III).
Successful management of a DTI requires a comprehensive assessment and management plan and the involvement of multiple health professionals. This may include: GP, Community Nurse, Wound / Spinal or Rehab Clinical Nurse Consultant, Occupational Therapist, Seating Therapist, Dietitian, Social Worker, Physiotherapist, Case Manager and Psychologist. An increase in personal care, domestic assistance, nutritional support and pressure management equipment is usually necessary.
