When we think of a skin injury we usually think of something that happens from the outside in such as a scrape, a cut, or a blister. As an in-home nurse practitioner specializing in wound care, I often see a much more deceptive type of wound: the Deep Tissue Injury (DTI).
Unlike a typical scrape, a DTI happens from the inside out. To help my patients and their families understand this I often use the “Iceberg Analogy.” Just as most of an iceberg’s mass is hidden beneath the ocean surface the most significant damage of a DTI is hidden beneath the skin’s surface.
What Exactly is a Deep Tissue Injury?
A deep tissue injury is a unique type of pressure injury. It appears as a localized area of skin that is deep red, maroon, or purple. Sometimes it looks like a dark, blood-filled blister.
While the skin might still be intact, the tissue underneath (the muscle and fat layers) has been damaged by intense or prolonged pressure. Because muscle is more sensitive to a lack of oxygen than skin is, it actually begins to break down first. By the time you see that “bruise” on the surface, the damage underneath has already begun.
Identifying the Warning Signs
Because DTIs can evolve quickly into more serious wounds, early detection is everything. If you are caring for a loved one at home keep an eye out for these three signs in areas where bone meets the bed. The more obvious places are the heels, hips or tail bones. Some other places that are often overlooked include the elbows, the back of the head, and the shoulder blades.
- Color Changes: Look for persistent deep red, purple, or maroon discoloration that doesn’t “blanch” (turn white or return to normal skin color) when you press on it. See the last blog post for how pressure injuries look different on different skin tones.
- Texture Shifts: Feel the skin. Does it feel mushier, firmer, warmer, or cooler than the surrounding area?
- Pain: Patients often report a deep, aching soreness in the area before the color even changes.
Why Do they Happen
Pressure is the primary culprit, but it’s rarely acting alone. Usually it is a combination of:
- Pressure: The weight of the body squeezing tissue against a hard surface like a mattress or a chair.
- Shear: The skin stays in place, but the bone and deep tissue slide, common when someone “slumps” down in a recliner.
- Microclimate: Moisture and heat on the skin can make it more vulnerable to breakdown.
How We Manage DTIs at Home
If I visit a patient and identify a DTI, our goal immediately shifts to “offloading.” We have to get the pressure off that spot completely. This might involve specialized foam dressings, “floating” the heels with pillows or utilizing high-tech pressure redistribution mattresses.
It is important to note that DTIs are unpredictable. Sometimes with excellent care and nutrition the body can reabsorb the damaged tissue. Other times the dark area may eventually open up to reveal a deeper wound. This is why professional monitoring is so vital.
The Takeaway
If you notice a “bruise” on a bedbound or chair bound loved one that looks darker than usual or feels different to the touch, don’t wait. Deep tissue injuries are a race against time. Early intervention is the best tool we have to protect the skin and promote healing from the inside out.
Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.
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