Skin Breakdown and TED Stockings

Skin Breakdown

• What is skin breakdown and what are some of the contributing factors?
• How is skin breakdown classified ?
• What anatomy is involved ?
• What role does the T.E.D. play in skin breakdown ?

What is Skin Breakdown ?

Skin breakdown or necrosis (death) of tissue occurs when oxygen and nutrients cannot reach cells at a site or sites on the body. The process causes tissue deterioration and eventual ulceration.

Factors contributing to skin breakdown include:

• Sensory impairment
• Decreased mobility
• Likelihood of friction or shear
• Deminished activity
• Presence or potential for prolonged moisture against skin
• Altered nutritional status
• Underlying disease process

How is skin breakdown classified ?

Stages of Pressure Ulcers:

Stage I. Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators.

Stage II. Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage III. Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage IV. Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g. tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressue ulcers.

Figure 1: Stages of Pressure Ulcers

• Stage 1 - skin is reddened but still intact
• Stage 2 - superficial damage to the skin, blisters develop due to continuous action of pressure
• Stage 3 - skin is deeply damaged, an open wound develops and muscles, tendons and ligaments are exposed
• Stage 4 - the defect also involves the bone

Anotomy of Skin Breakdown

Terminlogy you may hear:

• Blackened heels
• Heel ulcer
• Pressure sores
• Decubitus
• Debridement

Pressure Ulcers can occur anywhere:

• Bony prominences
  • Hip
  • Heel
  • Ankle
  • Elbow
  • Shoulder
• Pressure points
  • Sacrum
  • Under casts

Roles of T.E.D. Stockings in Skin Breakdown

• T.E.D. are not believed to be a primary cause of skin breakdown
• When T.E.D.s are removed regularly (minimum every shift), the problem escalates
• If stockings are not sized, applied and maintained properly, they may contribute to the problem

Take a pro-active approach with T.E.D.s. In-service T.E.D.s on sizing, application and maintenance. This will help minimize any potential for skin breakdown.