Differential Diagnosis for Sacral Wound
- Single most likely diagnosis
- Unstageable pressure injury: This is the most likely diagnosis because the wound has a slough-covered bed, which prevents accurate staging of the pressure injury. The presence of undermined edges and extension into soft tissue also supports this diagnosis, as it indicates significant tissue damage that cannot be fully assessed due to the slough.
- Other Likely diagnoses
- Stage 3 pressure injury: Although the wound's depth cannot be fully assessed due to slough, the description of the wound extending beyond the skin into the soft tissue is consistent with a Stage 3 pressure injury. However, the presence of slough makes it difficult to confirm the exact stage.
- Sacral osteomyelitis: The patient's elevated leukocyte count and the presence of a large, deep wound could suggest an infectious process such as osteomyelitis, especially in the context of a chronic wound. However, osteomyelitis would typically require additional diagnostic evidence such as imaging or bone biopsy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infected pressure injury with sepsis: Although the patient's laboratory studies are otherwise normal, the elevated leukocyte count and presence of a large wound could indicate an infected pressure injury. If left untreated, this could progress to sepsis, which is life-threatening.
- Necrotizing fasciitis: This is a rare but life-threatening condition that could present with a similar wound appearance. It requires prompt surgical intervention and would be a critical diagnosis not to miss.
- Rare diagnoses
- Malignancy (e.g., Marjolin's ulcer): Although rare, long-standing wounds can occasionally develop into malignant ulcers, such as Marjolin's ulcer. This would be an unusual presentation but should be considered if the wound does not heal as expected with appropriate treatment.
- Pyoderma gangrenosum: This is a rare skin condition that can cause large, painful ulcers. It might be considered if the wound does not respond to standard pressure injury treatment and other diagnoses have been ruled out.