In Stage 4 (full-thickness) pressure injuries, tissue loss extends into deep layers and may expose structures that are often misidentified. Precision in documentation isn’t only about “getting the stage right”—it helps anticipate functional impact and guides urgency of care.
Know the difference: Tendon = connects muscle to bone
Role: transmits force to create movement.
Why it matters: If a tendon is exposed and not protected, it can desiccate and lose viability—risking reduced active movement and strength (e.g., difficulty lifting the foot or extending a limb), depending on location.
Ligament = connects bone to bone
Role: provides joint stability and alignment.
Why it matters: Involvement near a joint can contribute to instability, altered mechanics, and higher fall risk—even after skin closure.
Why this matters clinically:Infection risk:
Exposed deep structures and nearby bone raise concern for deep infection, including osteomyelitis, especially when healing stalls or drainage/odor increases.
Complex care: Healing is often slower and may require advanced wound therapies (e.g., NPWT) and/or surgical evaluation depending on the wound and patient factors.
Rehab outcomes: We should look beyond “wound closure.” The deeper the injury, the more it can affect mobility, transfers, gait, and independence.
Naming the right structure helps the whole IDT align on severity, risk, and what’s at stake.
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