Deep Tissue Injury

Jenna Wishnew, MD, FACS

General Surgeon located in Richardson, TX

Deep tissue injury (DTI) is an injury to the underlying soft tissue just below the skin surface caused by prolonged pressure in an area of the body. A DTI restricts blood flow in tissues resulting in tissue death similar to a pressure ulcer. It usually appears purple, dark red or maroon discolored intact skin or blood-filled blister.


-          Constant pressure from a hard surface for an extended period

-          Shear from pulling or stretching of skin from sliding in an inclined bed or wheelchair



-          Age > 65 due to reduced subcutaneous fat and capillary blood flow

-          Immobilization i.e. Bedbound, wheelchair bound, paralysis, in coma or vegetative state

-          Decreased mobility i.e. Prolonged hospital stay, undergoing lengthy or complicated surgeries, weakness or cognitive impairment

-          Wearing casts, splints or prosthetic devices

-          Impaired capacity for wound healing secondary to malnutrition, diabetes, impaired tissue perfusion due to peripheral arterial disease or venous insufficiency

-          Chronic comorbidities i.e. Cancer, cerebral palsy, dementia, heart failure, kidney failure, spinal cord injury or spina bifida



-          Pressure offloading with turning, cushions, wedges, air loss mattress, etc.

-          Keep skin clean and dry

-          Increase protein in diet and optimized nutrition for wound healing (Hyperlinked)

-          Avoid massaging bony prominences

-          Skin barriers

-          Collagen

-          Wound dressings i.e. foam to cushion skin