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Suspected deep tissue injury.

History and Definition While believed to be a contemporary issue, deep tissue injury (DTI) has been noted in the literature since the late 1800s. DTI due to pressure exists as a form of pressure ulcer and is not well captured by the current staging system. Several pressure ulcer staging systems are frequently cited, but none defines pressure-related injury under intact skin. The National Pressure Ulcer Advisory Panel (NPUAP) recommended using the terms ‘pressure-related deep tissue injury under intact skin’ or ‘deep tissue injury under intact skin’ for describing these lesions. In 2002, the NPUAP defined deep tissue injury as “a pressure-related injury to subcutaneous tissue under intact skin.” Initially, these lesions have the appearance of a deep bruise. They may herald the subsequent development of a stage 3–4 pressure ulcer even with optimal treatment.