A physical therapist is evaluating a pressure ulcer on the left buttock that is relatively small and covered with black necrotic tissue. What must be done first to determine the stage of the ulcer?

• A. Gather information pertaining to the cause of the wound
• B. Debride the wound of the necrotic tissue
• C. Estimate the depth of the ulcer based on the thickness of tissue typically present in this area
• D. Make precise measurements of the surface area (i.e. perimeter) of the wound

Answer: (B)

When determining the stage of a pressure ulcer, the depth of tissue loss defines the stage, but necrotic tissue obscures that depth. The black tissue covers the wound bed like a scab over an iceberg, so you must debride the necrotic tissue to reveal the underlying structures and accurately assess how deep the damage goes. Debridement also helps with healing and infection risk by removing nonviable tissue and opens the wound to proper evaluation of whether there is partial-thickness loss or full-thickness loss involving deeper tissues. Gathering cause information or estimating depth by regional tissue thickness won’t reliably indicate the true depth, and measuring surface area doesn’t reveal depth either. Once the necrotic tissue is removed, you can assign the correct stage based on the visible tissue loss.