Most pressure injuries are about prevention: turning, repositioning, daily skin checks, and a good cushion. Our main guide on preventing and recognizing pressure injuries covers those basics, and it is the place to start.

This page is for the other situation: you (or the person you care for) already have a sore, and it is not getting better, or it is getting worse. That changes the math. A deep or stalled wound is not a "wait and see" problem. The single biggest predictor of whether a serious sore heals is how quickly and how completely it is taken off pressure, and how fast a skilled wound team gets involved. Acting early almost always means a shorter, easier recovery than waiting.

⚠️
A pressure sore that is getting larger, deeper, draining heavily, smelling bad, or not improving after a week or two is a reason to contact your doctor or a wound-care clinic now, not later. The longer a deep wound stays open, the higher the risk of bone infection and the more likely you will eventually need surgery.

Complete offloading: the non-negotiable

Here is the hard truth that no dressing, cream, or supplement can get around: a sore will not heal while you keep putting weight on it. Every minute of pressure on the wound squeezes shut the tiny blood vessels that are trying to deliver oxygen and nutrients to rebuild tissue. You can do everything else right and still watch the wound stall if it is being sat on or lain on for part of every day.

"Complete offloading" (also called total pressure relief) means exactly what it says: zero weight on the wound, all day and all night, until it has healed or until your team tells you otherwise.

There is no honest way to soften how disruptive this is. Complete offloading can mean weeks in bed, lost time at work or school, canceled activities, more help needed for daily tasks, and a real hit to mood and independence. Many people find this harder than the wound itself. It helps to think of it as a short, intensive investment: weeks of strict offloading now versus months of an open wound, or surgery, or a hospital stay later. Your team can help you build a livable plan for bed positioning, getting essentials within reach, and protecting your skin everywhere else while one area heals.

💡
If you cannot fully offload the wound at home, that is itself a reason to call your team. Sometimes a short admission or inpatient rehab stay is what finally lets a stubborn sore close, because it makes true round-the-clock pressure relief possible.

When to get specialist wound-care help

A primary care doctor or your regular SCI provider can manage many wounds. But certain signs mean it is time to bring in a wound-care clinic or a specialized wound team (which may include wound-care nurses, a plastic surgeon, infectious-disease, and a dietitian). Ask for a referral if the wound shows any of these:

Specialty wound teams can do things that are hard to do at home: careful removal of dead tissue (debridement), advanced dressings, pressure-mapping and seating assessment, treatment for infection, and decisions about whether imaging or surgery is needed. Getting them involved early often prevents the wound from reaching the point where surgery is the only option left.

Infection and bone infection (osteomyelitis)

An open wound is a doorway for bacteria. Watch for signs the wound is infected, and signs the infection is spreading beyond it.

Local infection (at the wound itself) can look like:

Spreading infection is more serious and can become an emergency. Get urgent medical care for:

⚠️
A pressure sore can trigger autonomic dysreflexia in people with injuries at T6 and above. The wound acts as a noxious stimulus below the level of injury. If you get a sudden pounding headache, sweating, flushing, or a spike in blood pressure and cannot find another cause, an infected or worsening sore may be the trigger. Treat AD as the emergency it is, and have the wound checked.

Osteomyelitis (bone infection). When a sore is deep, chronic, or has exposed bone, the infection can reach the bone underneath. This is called osteomyelitis, and it is one of the main reasons a deep pressure sore becomes hard to heal. Suspect it when a deep wound will not close despite good care, or when there is exposed or palpable bone. Diagnosing it usually involves imaging (such as an MRI) and, in many cases, a bone biopsy — a sample of the bone examined under a microscope and cultured. A biopsy is considered the most reliable test, because it both confirms the infection and identifies the exact bacteria so the right antibiotic can be chosen. Treatment, when bone infection is confirmed, typically means a prolonged course of antibiotics (often several weeks), and frequently surgery to remove infected bone and tissue. Osteomyelitis is not inevitable with a deep sore, but it is common enough that any deep, non-healing wound should be evaluated for it.

Nutrition: fueling the repair

Healing a wound is hard physical work for the body, and it cannot do it without raw materials. Undernutrition is one of the most common reasons wounds stall, and it is one of the most fixable. Two things matter most:

Staying well hydrated matters too, and so do certain micronutrients (such as zinc and vitamin C) when someone is deficient — though more is not automatically better, and supplements should be guided by a clinician rather than guessed at. The best move is to ask for a referral to a registered dietitian, ideally one familiar with SCI. A dietitian can calculate your real calorie and protein needs and build a realistic plan. Our guide to nutrition after spinal cord injury covers the day-to-day side of eating well.

Surgery and the flap reality

When a deep sore (usually stage 4, or one with bone involvement) will not heal with offloading and wound care alone, surgeons may consider surgical closure with a flap. In a flap operation, a surgeon removes the wound and any infected tissue or bone, then moves a section of nearby healthy skin, fat, and often muscle to fill the gap and cover the area with well-supplied tissue.

It can be the right choice and can close a wound that would never heal on its own. But it is a major operation with a demanding recovery, and it is worth understanding honestly before going in:

💡
The single most important thing you can do to make a flap "stick" is to change what caused the sore in the first place. That means a fresh seating and cushion assessment, a realistic repositioning routine, and the offloading and nutrition habits above, carried on for the long term, not just during recovery.

Support surfaces and a seating reassessment

A serious or recurring sore is a clear signal that the current setup is not protecting your skin well enough. Two things deserve a fresh look:

Our equipment guide covers cushions, support surfaces, and how to get the right gear evaluated and prescribed.

The thread running through all of this is the same: early action beats waiting. A sore caught and offloaded early may heal in a few weeks at home. The same sore ignored for months can mean bone infection, surgery, and a far longer road. When in doubt, get it looked at.

Sources

Information, not medical advice. A non-healing or worsening pressure injury needs assessment by a qualified clinician or wound-care team. Always consult your own healthcare providers about your situation.