- tender or painful if sensory nerves are intact - occurs over bony prominences - wound appearance: deeper ulcers covered with black eschar; may have exposure of tendons, bone, etc; tunneling/undermining common; may drain profusely - surround tissues: wound surrounded by a ring of erythema, non-blanchable erythema, warm to touch - keys to healing: moisturize skin, avoid excessive moisture, keep wound moist, debride if necessary, control infection, minimize shear and pressure forces, proper nutrition, pt education