Page 176 - Clinical Managers Orientation Binder

4/11/2019

Wound Depth Description Reference Text

Pick the depth, thickness most
appropriate to the wound using these
additional descriptions:

1. Tissues damaged but no break in skin surface.
2. Superficial abrasion, blister or shallow crater, even with,
&/or elevated above skin surface (e.g. hyperplasia)
3. Deep crater with or without undermining of adjacent
tissue.
4. Visualization of tissue layers no possible due to necrosis.
5. Supporting structures include tendon, joint capsule
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Deep Tissue Injury

 Purple or maroon localized area of
discolored intact skin
 Blood-filled blister

 Area may be preceded by tissue that is
painful, firm, mushy, boggy, warmer or
cooler as compared to adjacent tissue.

 Difficult to detect in individuals with dark
skin tones
NPUAP 2016

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