Deep tissue injury (FIG. 1)
Deep Tissue Injury (DTI) will have the appearance of a bruise. This will turn black in a few days (possibly up to 5 days or even more) and will continue to breakdown until all of the injured tissue has debrided and good tissue is exposed. Even if appropriate equipment and wound care products are used, this will not stop the inevitable breakdown of the injury. However, if used appropriately, they would prevent the injury in the first place.
It is referred to as an ‘Inside out’ pressure ulcer as the tissue will be breaking down next to the bone. It is possible that bacteria inside the body will attack the damaged tissue, along with putrescine and cadaverin and it will gradually break the tissue down until it is black and then yellow.
A DTI is likely to end up as a Category 3 or 4 but at this point still cannot be categorised.
This can sometimes be thought to be a bruise and treatment not initiated as the skin surface remains whole. However, inside the tissues are under attack and the system continues to break the tissues down inside, working the wound gradually from the inside to the outside and a large wound.
Sylvie Hampton, 22 November 2019