Clarity of layers
Localized hypoechoic region
Borders
Shape
Clear
Normal (Subcutaneous fat, fascia,
muscle, tendon, bone)
Unclear
None (low echogenicity/ cobble stone sign)
Inflammatory edema
Presence
Clear
Unclear
Internal echo
Homogeneous
Granulation
Heterogeneous (Cloud-like)
Necrotic tissue
Asymmetry/ triangle
Undermining
Round
Abscess
Site/depth: Check subcutaneous fat, fascia, muscle
Size and progression: Check the surrounding tissue
Scar/fibrosis
None (high echogenicity)
Classification of abnormalities
Observation
Observation
High risk for
deterioration
Fig. 7
Flowchart of pressure ulcer ultrasound
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