Holly M. Hovan, MSN, APRN, GERO-BC, CWOCN-AP
There has been much discussion surrounding unavoidable skin breakdown; however, the exact etiology remains unknown. Experts have discussed hypoperfusion and multiorgan system failure as contributing factors. Unavoidable pressure injuries typically have clinical features that distinguish them from true pressure injuries. These features include butterfly, pear, or horseshoe-shaped discoloration (maroon, red, purple, black), which quickly develop on the sacrum, buttock, spine, and extremities in the absence of external pressure. These areas of breakdown can evolve in hours, from intact skin to a deep wound exposing muscle, bone, or tendon, and they often develop in months, weeks, days, or hours prior to death.