The terms pressure sore, pressure wound, decubitus wound, decubitus ulcer, and pressure ulcer are often used interchangeably, though pressure ulcer is the preferred term. A pressure ulcer is an area of tissue ischemia or necrosis (death) due to persistent physical pressure over a defined area of skin. People with advanced age or neurological impairment, as well as those who are hospitalized, bedridden, or neglected, are at the highest risk. Pressure ulcers are staged based upon severity (Stage I-IV), though some are unstageable due to extensive tissue damage that precludes visualization of the ulcer base. Pressure ulcers lead to multiple complications including infection, sepsis, osteomyelitis, and malignant transformation. Consequently, pressure ulcer prevention is a critical task in modern medicine, and a fertile area for liability. Stage I and II pressure ulcers are often treated with pressure reduction and wound care, while Stages III and IV typically require surgery. Conservative care is often performed by nurses under the direction of an attending physician. Specialized nurses have advanced certification in Wound Care and may bear credentials such as CWCN (Certified Wound Care Nurse), WCC (Wound Care Certified), or CWOCN (Certified Wound Ostomy Continence Nurse). Wounds requiring complex medical and/or surgical intervention typically rely upon wound care specialists from the fields of Plastic Surgery or General Surgery. These surgical specialists, many of whom have undertaken Fellowship training in Wound Care, routinely perform wound debridement (excision of devitalized tissue), wound reconstruction, and skin grafting.
WOUND CARE AND PRESSURE ULCER expert witnesses are required in a number of situations in medical malpractice litigation. The most common allegations involve departures from the standard of care that led to pressure ulcer formation in the first place, or the failure to recognize, stage, and treat pressure ulcers in a timely manner. Wound Care experts are also required to analyze issues of harm and causation. Depending on the unique requirements of the case, the optimal experts may be certified nurses, wound care surgeons, or both.