Bob VogelQ. I’m 55 and in my 20th year as a C7 quad. I stay active, eat a healthy diet and do nightly “mirror-skin-checks.” My skin has always looked good with no red areas until six months ago when I got a minor scrape on my butt cheek during a transfer. Within a week it swelled and opened up and was diagnosed as a deep tissue injury. I ended up needing a skin flap and many months in bed to heal.

I’ve used an air flotation cushion since rehab. It has always protected my skin. My wound care specialist said that new research in pressure injury suggests that over the years, scar tissue has likely been slowly developing deep in the tissues near my ischium, and the scrape likely set the wound in motion.

This is the first time I’ve heard of a deep tissue injury, and I’m still trying to wrap my head around how this happened. Anything you can tell me about it, especially options to avoid another one, will be appreciated.

— Stacy

A. As in many areas of medicine, researchers’ knowledge of how pressure sores — now often referred to as “pressure injuries”— continues to evolve. Until the early 2000s, known causes of tissue injury were pressure — which red