Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries

Amit Gefen, David M. Brienza, Janet Cuddigan, Emily Haesler, Jan Kottner*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up-to-date evidence-based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.

Original languageEnglish
Pages (from-to)692-704
Number of pages13
JournalInternational Wound Journal
Issue number3
StatePublished - Mar 2022


  • aetiology
  • pressure injury
  • pressure ulcer
  • risk


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