Bob VogelQ. I’m 63 and in my 26th year as a T11 complete para. I’m healthy, I eat right, I stay active and I still do a “mirror-check” of my skin every morning.  My skin has always looked fine and I never had a pressure sore until last year when out of nowhere my right buttock became discolored and swelled up. I thought it was a blood clot, so I immediately went to my doc’s office. It turned out I had a bad pressure sore that had started at the ischium and worked its way out. I ended up needing skin flap surgery, and it cost me three months flat on my stomach.

I had been using the same brand of foam cushion since I got out of rehab.  Thinking back, I hadn’t replaced my cushion in seven years. After I healed, I got pressure-mapped and found the type of cushion I was using no longer provided the support my skin now needs. I switched to an air flotation cushion for my chair and bought another one — low profile — for my car seat. But none of this explains why I suddenly got this pressure sore.

Nobody has been able to tell me what might have caused this. The idea of another one appearing out of nowhere really scares me.

— Dan

A. Dan, since you were diligent about doing daily skin checks, and a major pressure sore still appeared with no warning, your story gave me a scare as well. So I ran it by a few experts. Based on your description, you may want to ask your doctor or wound care specialist if you had a “suspected deep tissue injury.”

Darren Hammond, MPT, certified wound specialist and senior director of the ROHO Institute for Continuing Education and Research, offers insight on this type of pressure sore. Hammond explains that while skin is very resilient — partly because it is one of the most vascular organs in the body — underlying tissue is less vascular and more susceptible to damage.

To understand the ramifications of Hammond’s explanation, it is important to know that the National Pressure Ulcer Adviso