Named after the person who first introduced it at the National Pressure Injury Advisory Panel in Washington in 1989, Karen Lou Kennedy-Evans, KTUs are often mistaken for pressure wounds, but have some markedly different traits.
KTUs develop in the near-death patient’s sacrum, the triangle-shaped space in a person’s lower back also known as the tail bone. “There is a phenomenon of skin breakdown that is unavoidable at the end of life […] I don’t think we see it on every dying patient, but when we see it, because it presents as a purple or maroon area, it tends to get classified as a DTI [deep tissue injury],” shared Joyce Black, a registered nurse and National Pressure Injury Advisory Panel (NPIAP) Board Executive Committee Member (via Medline).
KTUs differ from typical pressure wounds in that they can quickly develop from a pear-shaped bruise to an irregular-shaped ulcer by the end of the day. Also, they can pop up suddenly and manifest in a few different colors (like red, yellow, purple, black, and blue). You will know tissue death has started happening when the bruise or ulcer turns darker and becomes swollen. Experts think that the reason those who are dying develop KTUs is similar to why they develop a lot of symptoms related to gradual organ failure. In this case, the organ that’s failing is their skin.