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The VCU Pressure Ulcer Summit

The Search for a Clearer Understanding and More Precise Clinical Definition of the Unavoidable Pressure Injury

Alvarez, Oscar M.; Brindle, C. Tod; Langemo, Diane; Kennedy-Evans, Karen Lou; Krasner, Diane L.; Brennan, Mary R.; Levine, Jeffrey M.

Journal of Wound Ostomy & Continence Nursing: September/October 2016 - Volume 43 - Issue 5 - p 455–463
doi: 10.1097/WON.0000000000000255
Wound Care

This article reports the findings of the Unavoidable Pressure Ulcer Committee (of the VCU Pressure Ulcer Summit) that was tasked with addressing key issues associated with pressure injuries that are unavoidable or unpreventable. Our goals were (1) to clarify nomenclature and descriptions surrounding “terminal ulceration,” (2) to describe the medical complications and comorbid conditions that can lead to skin failure and/or terminal ulceration, (3) to describe the variable possible causes of unavoidable pressure injuries, and (4) to present clinical cases to exemplify pressure injuries considered to be unavoidable.

Oscar M. Alvarez, PhD, CCT, FAPWCA, Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, New York; and Department of Medicine, New York Medical College, Valhalla.

C. Tod Brindle, MSN, RN, CWOCN, VCU Medical Center Wound Care Team, Richmond, Virginia.

Diane Langemo, PhD, RN, FAAN, University of North Dakota College of Nursing, Grand Forks.

Karen Lou Kennedy-Evans, RN, FNP, APRN-BC, Kennedy, LLC, Tucson, Arizona.

Diane L. Krasner, PhD, RN, CWCN, CWS, MAPWCA, FAAN, Harrisburg area Community College–York Campus, York, Pennsylvania.

Mary R. Brennan, MBA, RN, CWON, FACCWS, North Shore University Hospital, Manhasset, New York.

Jeffrey M. Levine, MD, AGSF, CWSP, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York.

Correspondence: Oscar M. Alvarez, PhD, CCT, FAPWCA, University Wound care Centers, 3175 East Tremont Ave, Bronx, NY 10461 (

The authors declare no conflicts of interest.

© 2016 by the Wound, Ostomy and Continence Nurses Society.