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This morning I did Grand Rounds for the Baylor Department of Geriatrics (via Zoom, of course!), discussing a new paradigm for pressure ulcer formation. I’ve blogged about this before, and published a paper about it.

If you would like to think about something OTHER than COVID-19, check out the PDF below (or download it here) from my Grand Rounds presentation today – an iconoclastic idea of how Stage 1 Pressure injuries, Deep Tissue Injuries and Stage 4 pressure injuries form. I make a compelling case that Stage I pressure injuries are ischemia reperfusion events, while DTIs and Stage 4 PIs are tissue infarctions – both the result of a vascular occlusion (artery or vein) proximal to the lesion. That would mean that pressure injuries are not all due to LOCAL pressure, but in some cases, pressure that occurs proximal to the visible lesion and perhaps in a named vessel that supplies the vascular territory.

New Paradigm of Pressure Injury

I have a photo challenge for you (please, don’t send me any photos!). Look at the photos you have taken of Stage 1 PIs, DTIs and Stage 4 PIs, and find one that CANNOT be explained by ischemia or infarction of a vessel that supplies that territory. Here’s a link to a map of vascular territories.

The anatomical distribution is pretty convincing, isn’t it?

If you would like to watch pressure injuries form from the inside to the outside – check out the playlist below from the Caroline Fife M.D. You Tube channel, (and please subscribe, there’s much more where these came from!)


Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.



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