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June 1991

Classification of Pressure Ulcers-Reply

Author Affiliations

Rehabilitation Institute of Chicago 345 E Superior St Chicago, IL 60611

Arch Dermatol. 1991;127(6):908. doi:10.1001/archderm.1991.01680050154022

In Reply.—  We agree with the authors that when eschar is present débridement is often necessary to determine the extent of the ulceration and that palpation may assist as well.Our classification of red areas1 reflects our clinical practice of intervening if hyperemia persists for greater than 30 minutes.2 It is not necessary to wait for greater than 24 hours to institute therapeutic measures. Our approach is, in fact, more conservative than the authors outline. Of course, if their method has proven successful in their institutions, it can be used as long as there is sufficient interrater reliability.Muscle is frequently observed at the base of pressure ulcers. These ulcerations may occur in both common and uncommon areas and a classification including muscle is needed to classify all possible lesions. Patients who have had musculocutaneous flaps will certainly have muscle exposed if pressure ulcerations reoccur. We find grade IV to be

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