The Shea Grading System for Pressure Ulcerations

acute inflammatory reaction involving all soft tissue layers of the skin with erythema of skin; moist irregular partial thickness ulceration limited to the epidermis exposing the underlying dermis may be present

I

acute inflammatory reaction involving all soft tissue layers with a full thickness skin ulcer involving the dermis; may extend to but not go into the underlying subcutaneous fat

II

ulcer extensively involving the subcutaneous fat with undermining of the skin and limited by deep fascia; often necrotic, infected and foul-smelling; patient may be toxic with systemic symptoms

III

ulcer has penetrated the deep fascia; extensive soft tissue spread, osteomyelitis and/or septic and dislocated joints; patient usually highly toxic

IV

large cavity draining through a relatively small sinus, typically overlying a bony prominence; with/without muscle and bone involvement

closed

I

local wound care

II

local wound care

III

surgical debridement

IV

radical surgery

closed

surgery with wide excision