Pressure Sores

Pressure sores, also known as decubitus ulcers or bedsores, are areas of skin and tissue damage that develop when sustained pressure compromises blood flow to the affected area. In rabbits, these sores most commonly develop over bony prominences such as the hocks (ankle area), elbows, spine, and hips, where minimal soft tissue exists between the skin and underlying bone. While pressure sores are closely related to pododermatitis (sore hocks), which specifically affects the plantar surface of the feet, the term pressure sores more broadly encompasses ulceration at any site resulting from prolonged pressure, reduced mobility, or inadequate cushioning. These wounds range from mild superficial skin damage to severe ulceration extending to bone.

Pressure sores develop through a predictable mechanism involving sustained pressure that exceeds the pressure within blood capillaries. When blood flow is restricted for prolonged periods, tissue is deprived of oxygen and nutrients while waste products accumulate. This leads to cell death and tissue breakdown. The process is accelerated by friction (which damages the skin surface), shearing forces (which disrupt blood vessels in deeper layers), and moisture (which macerates the skin and increases susceptibility to damage). Rabbits are particularly vulnerable to pressure sores because they spend much of their time in resting positions, have thin skin over bony areas, and may have limited ability to shift position if mobility is compromised.

Several categories of rabbits face elevated risk for pressure sore development. Rabbits with paralysis or paresis affecting the hindquarters, often from spinal injury, E. cuniculi infection, or spondylosis, cannot shift position normally and may develop sores within days. Elderly rabbits with arthritis move less frequently and may be unable to assume comfortable positions that distribute weight evenly. Obese rabbits have increased pressure over weight-bearing areas and may have impaired circulation. Rabbits housed on inappropriate flooring such as wire mesh, hard tile, or abrasive surfaces experience constant trauma to contact areas. Rabbits recovering from illness or surgery who are less mobile than usual face temporary increased risk.

Treatment of pressure sores requires addressing the underlying cause of pressure while providing wound care for existing damage. This often means modifying the rabbit's environment to provide soft, supportive surfaces and addressing any medical conditions limiting mobility. Wound management varies from simple topical care for mild lesions to intensive treatment potentially including surgery for severe cases. Prevention is significantly more effective than treatment, as established pressure sores are difficult to heal while the underlying risk factors persist. A rabbit-savvy veterinarian should evaluate any rabbit with pressure sores to assess severity, identify contributing factors, and develop an appropriate management plan, as these wounds can become chronic and seriously impact quality of life.

The primary cause of pressure sores is sustained pressure on tissue that exceeds capillary closing pressure, which is approximately 32 mmHg in most tissues. When external pressure exceeds this threshold for prolonged periods, blood flow is occluded, preventing oxygen and nutrient delivery to cells and waste removal from them. Tissues can tolerate short periods of ischemia, but extended pressure causes irreversible cell death. The severity of damage depends on both the magnitude and duration of pressure, with higher pressure causing damage more quickly. Even relatively low pressure can cause tissue breakdown if sustained long enough, which explains why immobile patients develop pressure sores even on padded surfaces.

Mobility limitations are among the most significant risk factors for pressure sores in rabbits. Healthy rabbits frequently shift position, redistributing pressure and allowing blood flow to recover in previously compressed areas. Rabbits with conditions affecting mobility cannot perform these protective movements. Hindquarter paralysis from spinal injury, E. cuniculi infection, or vertebral fracture creates high risk because affected rabbits cannot reposition their rear end and may sit in urine or feces that further damages skin. Arthritis makes position changes painful, reducing their frequency. Spondylosis (spinal arthritis), particularly common in older and larger rabbits, causes both pain and reduced flexibility. Neurological conditions may impair awareness of pressure discomfort that would normally prompt movement.

Environmental factors significantly contribute to pressure sore development. Wire-bottomed cages cause constant pressure points at the mesh intersections and lack cushioning. Hard flooring surfaces including tile, hardwood, and concrete provide no pressure distribution or absorption. Abrasive surfaces like some commercial cage mats can cause friction damage. Inadequate bedding fails to protect against hard underlying surfaces. Damp bedding from urine, water spills, or inadequate absorption macerates the skin, increasing vulnerability to pressure damage. Small enclosures that restrict movement prevent normal position changes. Temperature extremes can affect tissue vulnerability, with cold reducing circulation and heat increasing metabolic demands.

Several rabbit-specific factors increase susceptibility to pressure sores. Rex and Mini Rex breeds have shorter, less dense fur that provides less cushioning over bony prominences, making them particularly prone to sore hocks and other pressure injuries. Large breed rabbits carry more weight on their feet and contact points. Obesity increases pressure on weight-bearing areas while potentially impairing circulation. Underweight rabbits have less protective soft tissue over bones. Poor nutrition compromises skin integrity and healing capacity. Chronic illness or debilitation from any cause reduces overall tissue resilience. Some rabbits may have individual variation in skin durability or healing ability.

The mechanism of pressure sore development involves several related processes. Direct pressure compresses blood vessels, causing ischemia. Shearing forces, which occur when layers of tissue slide against each other as the rabbit shifts, disrupt small blood vessels within the tissue. Friction damages the skin surface, removing protective layers. Moisture from urine, feces, or wet bedding macerates the epidermis, making it fragile and more easily damaged. Once the skin barrier is broken, bacteria can invade, leading to infection that further damages tissue. Deep pressure sores may extend through subcutaneous tissue to involve muscle, tendon, or bone, creating serious complications including osteomyelitis (bone infection).

Early warning signs of pressure sore development may be subtle and require careful observation to detect. The first indication is often a change in the fur or skin over pressure points, particularly the hocks. The fur may appear worn, thin, or discolored. The skin beneath may appear slightly pink or red when the fur is parted. The rabbit may show subtle behavioral changes such as shifting weight more frequently, reluctance to place full weight on affected limbs, or changes in resting posture. Careful palpation may reveal areas of warmth indicating inflammation or areas of firmness indicating developing tissue damage. These early changes represent an opportunity for intervention before open wounds develop.

As pressure sores progress, symptoms become more obvious. Hair loss over the affected area reveals reddened, inflamed skin. The skin may appear thickened, hardened, or calloused in early stages as the body attempts to protect against ongoing pressure. With continued damage, the skin breaks down, forming open wounds. These wounds may be superficial initially, appearing as raw, reddened areas or shallow ulcers. The sores may weep clear or blood-tinged fluid. Scab formation over wounds indicates tissue loss. Multiple pressure points may be affected simultaneously, particularly in immobile rabbits, with sores developing over hocks, elbows, hip points, or spine.

Behavioral changes associated with pressure sores reflect the discomfort they cause. Affected rabbits may be reluctant to move, sit in unusual positions, or favor certain limbs. They may resist handling, particularly of affected areas. Teeth grinding (bruxism), a sign of pain in rabbits, may be audible. Decreased appetite is common with painful conditions and is particularly concerning because reduced food intake in rabbits can rapidly trigger life-threatening GI stasis. The rabbit may seem depressed, less interested in surroundings, or withdrawn from normal activities. Changes in elimination habits may occur if movement is painful.

Physical examination findings vary with pressure sore severity, typically classified using a staging system. Stage 1 sores show intact skin with non-blanchable redness, possibly with warmth or firmness. Stage 2 sores demonstrate partial thickness skin loss with a shallow open wound, blister, or abraded area. Stage 3 sores involve full thickness skin loss with visible subcutaneous fat but no exposed bone, tendon, or muscle. Stage 4 sores show full thickness tissue loss with exposed bone, tendon, or muscle, representing the most severe category. Unstageable sores are covered with dead tissue (eschar or slough) obscuring the wound base. Additionally, deep tissue injury may present as a localized area of discolored, boggy, or firm tissue indicating damage beneath intact skin.

Pressure sores follow a progression from early tissue damage to established wounds and potential complications. Initial damage may be invisible on the surface while tissue death occurs in deeper layers, later manifesting as dramatic surface breakdown. Shallow wounds may deepen over days to weeks if pressure continues. Secondary bacterial infection, indicated by increased redness, swelling, discharge, warmth, and odor, accelerates tissue destruction. Infection can spread to underlying bone (osteomyelitis), which is extremely difficult to treat. Without intervention, pressure sores typically worsen progressively as long as causative factors persist.

Emergency symptoms warranting immediate veterinary attention include any signs of severe or spreading infection such as extensive redness, purulent discharge, foul odor, or systemic signs including fever, lethargy, or collapse. Wounds with exposed bone or tendon require urgent professional management. Any rabbit refusing to eat for more than 12 hours needs immediate attention regardless of the cause, as GI stasis can be fatal within 24-48 hours. Sudden worsening of existing wounds or dramatic tissue changes suggest acute complications requiring prompt evaluation. Rabbits with hindquarter paralysis showing any new skin changes need assessment given their high vulnerability to rapid wound progression.

Diagnosis of pressure sores begins with a comprehensive history and physical examination by a rabbit-savvy veterinarian. The veterinarian will ask about the rabbit's housing conditions, including enclosure type, flooring surface, and bedding materials. Questions about mobility, activity level, and any conditions affecting movement help identify risk factors. Medical history including previous pressure sores, spinal problems, E. cuniculi diagnosis, or other health issues provides context. Information about when skin changes were first noticed, whether they have progressed, and what interventions have been attempted guides assessment. The rabbit's diet and weight history may reveal nutritional factors affecting skin health.

Physical examination includes thorough evaluation of all potential pressure points and assessment of underlying conditions. The veterinarian will examine hocks, elbows, hips, spine, and any other areas where the rabbit's body contacts resting surfaces. Each lesion is assessed for depth, extent, signs of infection, and surrounding tissue health. The examination notes whether wounds are acute or chronic, clean or infected, and superficial or deep. Full body condition is assessed, including weight, muscle mass, and nutritional status. Mobility evaluation identifies limitations in movement that contribute to pressure sore risk. Neurological examination may be indicated if paralysis or paresis is present or suspected.

Diagnostic tests help assess overall health, identify complications, and may investigate underlying conditions. Blood work including complete blood count and biochemistry panel evaluates for systemic infection, nutritional deficiencies, and organ function. If infection is evident, wound cultures identify specific bacteria and guide antibiotic selection. Radiographs may be performed to assess for bone involvement (osteomyelitis) in severe cases or to evaluate spinal conditions that might be contributing to mobility limitation. Serologic testing for E. cuniculi may be considered if this infection might be causing mobility problems. Additional testing depends on individual circumstances and suspected contributing conditions.

Differential diagnosis considers other conditions that might cause skin lesions at pressure points. Pododermatitis (sore hocks) specifically affects the plantar surface of the feet but has similar causes and management to pressure sores elsewhere. Abscesses can develop at pressure points, particularly if bacteria enter through damaged skin. Mite infestations can cause skin changes at various locations. Trauma from cage components, other animals, or self-mutilation produces wounds that might occur at pressure points coincidentally. Ischemic necrosis from vascular compromise has similar appearance to pressure sore tissue damage. Tumors rarely may develop at sites of chronic irritation. Accurate diagnosis ensures appropriate treatment and identifies any underlying conditions requiring attention.

Initial treatment for pressure sores focuses on relieving pressure from affected areas and initiating wound care. This begins with environmental modification to provide soft, supportive surfaces that distribute weight and cushion bony prominences. Thick, soft bedding such as fleece blankets, padded mats, or deep layers of appropriate bedding material reduces pressure on vulnerable areas. Position changes should be facilitated, either through the rabbit's own movement or, for immobile rabbits, by gently repositioning the rabbit every two to four hours. Any sources of friction, shear, or moisture must be addressed. For immobile rabbits, positioning devices or padded supports may help distribute weight more evenly.

Wound care approaches depend on the stage and condition of the pressure sore. Superficial wounds (Stage 1-2) may be managed with gentle cleaning using saline or dilute antiseptic solutions, application of topical medications as directed by the veterinarian, and protection with light dressings if needed. Deeper wounds (Stage 3-4) require more intensive management that may include debridement (removal of dead tissue), wound packing, specialized dressings, and close monitoring for infection. Infected wounds need appropriate rabbit-safe antibiotics, typically systemic for significant infection. Wound dressing selection depends on wound characteristics, with options including hydrocolloid dressings for shallow wounds, foam dressings for moderate exudate, alginate for heavily draining wounds, or antimicrobial dressings for infected wounds.

Surgical intervention may be necessary for severe or non-healing pressure sores. Surgical debridement removes dead and infected tissue more thoroughly than conservative methods. Deep abscesses may require drainage and packing. In cases of osteomyelitis (bone infection), bone debridement or amputation may be necessary. Severe chronic wounds occasionally require surgical closure techniques such as skin flaps. All surgical procedures in rabbits require an experienced exotic veterinarian familiar with rabbit-specific anesthesia protocols, and rabbits should not be fasted before surgery. The decision to pursue surgery weighs the benefits against anesthesia risks and the likelihood of successful healing.

Medical management supports wound healing and addresses complications. Pain management is essential, as untreated pain leads to decreased appetite and GI stasis, which can be fatal. Meloxicam is commonly used for pain and inflammation in rabbits. Additional pain medications may be needed for severe cases. Antibiotics are prescribed for infected wounds using only rabbit-safe options such as enrofloxacin or trimethoprim-sulfa. Nutritional support ensures adequate protein, calories, and micronutrients for tissue repair. Subcutaneous fluids may be given if hydration is compromised. Any underlying conditions contributing to immobility should be treated, which might include E. cuniculi treatment, arthritis management, or other specific therapies.

Supportive care throughout treatment ensures the rabbit maintains overall health while wounds heal. Maintaining adequate nutrition is critical because tissue repair requires substantial metabolic resources. If appetite is reduced, syringe feeding with critical care formula prevents GI stasis and provides calories and nutrients. The rabbit should be kept clean and dry, with any urine or fecal soiling cleaned promptly to prevent additional skin damage. The environment should be warm enough for comfort without overheating. Gentle range-of-motion exercises, if tolerated, help maintain mobility and circulation. Mental stimulation and social interaction support overall wellbeing during what may be a prolonged recovery period.

Treatment decisions depend on wound severity, the rabbit's overall condition, underlying causes, and practical factors including owner resources and commitment. Mild superficial pressure sores may heal within weeks with environmental modification and basic wound care. Severe wounds with complications may require months of treatment with guarded prognosis. The likelihood of successful healing depends significantly on whether causative factors can be adequately controlled. For rabbits with permanent mobility limitations, ongoing prevention is as important as healing current wounds. Quality of life must be honestly assessed, as chronic non-healing pressure sores can cause significant suffering, and humane euthanasia may be appropriate in some cases.

Recovery from pressure sores varies enormously depending on wound depth, underlying health conditions, and ability to modify causative factors. Superficial Stage 1-2 pressure sores may heal within two to four weeks with appropriate pressure relief and wound care. Deeper Stage 3-4 wounds typically require six to twelve weeks or longer for complete healing, and some may take months or remain chronic wounds requiring ongoing management. The most important factor determining healing success is effective pressure relief; without removing the cause, wounds cannot heal regardless of other treatments provided. Secondary factors including nutritional status, concurrent illness, and wound infection also significantly affect healing time.

Post-treatment care maintains conditions that allowed healing to occur and prevents recurrence. Pressure relief measures must continue indefinitely for rabbits with ongoing risk factors such as mobility limitations. This means maintaining soft, supportive bedding, facilitating position changes, keeping the rabbit clean and dry, and monitoring for any signs of new pressure damage. Healed pressure sore sites often have thin, fragile scar tissue that is more vulnerable to re-injury than normal skin, requiring ongoing protection. Follow-up veterinary appointments assess healing progress and allow early detection of any problems. Weight management continues if obesity was a contributing factor.

Prognosis depends on multiple factors and varies widely between individual cases. Rabbits with mild pressure sores caused by correctable environmental factors have excellent prognosis if appropriate changes are made. Those with permanent mobility limitations face ongoing risk of recurrence, making prognosis for long-term wound-free status guarded despite successful healing of individual lesions. Severe wounds with complications such as osteomyelitis have guarded to poor prognosis for complete healing. The presence of underlying systemic illness affects both healing capacity and overall prognosis. Commitment to ongoing prevention measures significantly influences long-term outcomes.

Long-term outlook for rabbits that have developed pressure sores requires acknowledgment that risk factors often persist. Rabbits with permanent mobility limitations require lifelong intensive management to prevent recurrence. Environmental modifications must be maintained consistently. Weight must be kept in healthy range. Any new skin changes at pressure points require immediate attention before wounds develop. Regular veterinary monitoring helps detect problems early. With dedicated care, many rabbits with high-risk conditions can live comfortably for extended periods without developing new pressure sores, but this requires ongoing vigilance and commitment from caregivers.

Primary prevention of pressure sores centers on providing appropriate environmental conditions and maintaining the rabbit's mobility and overall health. Housing surfaces should be soft and supportive, distributing pressure rather than concentrating it at contact points. Avoid wire-bottomed cages or any hard, unpadded flooring. Provide multiple layers of soft bedding, fleece blankets, padded mats, or thick padding that cushions bony prominences. The enclosure should be large enough to allow normal movement and position changes. Regular cleaning maintains dry conditions, as moisture dramatically increases pressure damage risk. Replace wet or soiled bedding promptly.

Environmental modifications are especially important for rabbits with mobility limitations or other risk factors. Paralyzed or paretic rabbits need the softest possible bedding with frequent repositioning. Use materials that wick moisture away from the skin, such as fleece over absorbent padding. Create a setup that allows position changes with assistance while preventing the rabbit from lying in urine or feces. For arthritic rabbits, low-sided litter boxes, ramps instead of steps, and padded resting surfaces reduce strain and encourage movement. Temperature control prevents vasoconstriction from cold that impairs circulation. Regular bedding changes prevent ammonia buildup that damages skin.

Dietary management supports skin health and appropriate body weight. Proper nutrition including adequate protein supports skin integrity and healing capacity. Unlimited grass hay provides fiber essential for gut health and prevents obesity. Limit pellets and treats to appropriate amounts to maintain healthy weight. Fresh leafy greens provide vitamins and minerals important for skin health. Adequate hydration supports tissue health and elasticity. Avoid obesity, which increases pressure on contact points and may impair circulation, but also maintain adequate nutrition to avoid tissue wasting that reduces protective cushioning.

Regular health maintenance identifies and addresses risk factors before pressure sores develop. Schedule routine veterinary examinations to detect mobility problems, weight changes, or other issues that increase pressure sore risk. Monitor your rabbit's mobility, watching for signs of arthritis, pain, or neurological problems that might reduce position changes. Check pressure points regularly, at least weekly, looking for any fur changes, redness, or skin abnormalities. Know your rabbit's normal activity level and behavior so changes that might indicate developing problems are noticed quickly. Address weight gain promptly before obesity becomes established.

Early intervention prevents mild skin changes from progressing to established wounds. At the first sign of fur loss, redness, or skin changes at pressure points, increase padding and bedding, assess for contributing factors, and increase monitoring frequency. Implement position changes if the rabbit is not moving adequately on its own. Address any moisture problems immediately. If skin changes persist or worsen despite environmental improvements, seek veterinary evaluation before wounds develop. Early stage pressure damage is much easier to reverse than established pressure sores.

Daily management for rabbits with or at risk for pressure sores requires consistent attention to environmental conditions, skin assessment, and overall health monitoring. Check all pressure points at least twice daily, looking for any redness, warmth, swelling, or skin changes. For rabbits with existing wounds, perform wound care as directed by your veterinarian, typically involving gentle cleaning and dressing changes. Ensure bedding remains clean, dry, and adequately padded, changing it as often as needed which may be multiple times daily for incontinent rabbits. Monitor food and water intake, as appetite changes may indicate pain or developing illness. Track fecal output as an indicator of gut health.

Home environment management is central to preventing pressure sores and allowing existing wounds to heal. Maintain multiple layers of soft, supportive bedding at all times. For high-risk rabbits, consider using pressure-distributing surfaces designed for at-risk patients. Position food and water where the rabbit can access them without prolonged pressure on vulnerable areas. For immobile rabbits, establish a routine of repositioning every two to four hours around the clock to prevent sustained pressure on any single area. Use rolled towels or positioning aids to maintain comfortable positions. Keep the environment warm enough for comfort as cold can impair circulation.

Quality of life assessment is essential when managing rabbits with chronic pressure sore risk or difficult wounds. Rabbits should be able to eat, eliminate, and rest comfortably. Pain should be adequately controlled such that the rabbit shows interest in surroundings and engages in at least some normal behaviors. If intensive management is required, the sustainability of this level of care must be considered honestly. Some rabbits with permanent mobility limitations can maintain excellent quality of life with dedicated care, while others experience ongoing suffering despite best efforts. Regular reassessment helps ensure that management decisions remain in the rabbit's best interest.

Ongoing monitoring and veterinary care support long-term health and early problem detection. Schedule regular follow-up appointments as recommended, typically more frequently for high-risk rabbits or those with healing wounds. Report any new skin changes promptly rather than waiting for scheduled appointments. Keep records of wound healing progress, daily observations, and any concerns for discussion with your veterinarian. Continue treatment for underlying conditions contributing to pressure sore risk. Be alert to signs of systemic illness that might indicate wound complications or other health problems.

Caregiver support is crucial because managing a high-risk rabbit can be physically and emotionally demanding. Caring for a disabled or immobile rabbit requires significant time commitment, potentially including round-the-clock repositioning and frequent wound care. Connect with rabbit rescue organizations and online communities for practical advice and emotional support from others who have faced similar situations. Develop sustainable routines that provide necessary care without caregiver burnout. Financial planning helps manage ongoing costs of medical care, supplies, and potential complications. If care demands exceed your capacity, discuss options with your veterinarian, including whether the management plan should be modified or whether the rabbit's quality of life is adequate.

Certain rabbit breeds face elevated risk for pressure sores due to their physical characteristics. Rex and Mini Rex rabbits are particularly susceptible because their unique coat structure, with short, dense, velvety fur lacking normal guard hairs, provides less cushioning over bony prominences than standard rabbit coats. These breeds commonly develop sore hocks and are vulnerable to pressure damage elsewhere as well. Extra attention to soft bedding and regular foot checks is essential for Rex breeds. English Spots and other breeds that historically were shown on hard surfaces may have predisposition to sore hocks that extends to general pressure vulnerability.

Size-related factors influence pressure sore risk across breed categories. Giant breeds including Flemish Giants, Continental Giants, French Lops, and Giant Chinchillas carry more weight on their contact points, increasing pressure-related stress on tissues. These breeds are also prone to spinal problems such as spondylosis that reduce mobility and increase overall pressure sore risk. Conversely, very small breeds may develop proportionally significant pressure damage from surfaces that adequately accommodate larger rabbits. Obese rabbits of any breed face compounded risk from increased weight plus the metabolic effects of excess body condition.

Screening and prevention recommendations apply to all breeds with heightened attention for those at elevated risk. Rex and Mini Rex rabbits require particularly soft bedding from the beginning of ownership and regular inspection of hocks and other pressure points. Giant breeds should be monitored for early signs of mobility limitation and provided supportive housing before problems develop. All rabbits benefit from appropriate flooring, adequate bedding, and environmental conditions that prevent pressure sore development. Regardless of breed, any rabbit showing mobility limitations, weight problems, or early skin changes at pressure points needs prompt attention. Regular veterinary examinations help identify risk factors before wounds develop.

Pressure sores are closely related to and commonly co-occur with several other conditions. Pododermatitis (sore hocks) specifically affects the plantar surface of the feet and shares causative factors with pressure sores elsewhere, including inadequate bedding, mobility limitations, and obesity. Many rabbits with pododermatitis also have or develop pressure sores at other locations. GI stasis may develop secondary to pressure sore pain, as discomfort causes decreased appetite and activity, leading to dangerous slowing of gut motility. Any rabbit with pressure sores should be monitored closely for signs of GI stasis including reduced eating, smaller or absent fecal pellets, and lethargy. Urinary scald (hutch burn) often accompanies pressure sores in immobile rabbits who cannot avoid lying in their own urine.

Several conditions may be confused with or need to be distinguished from pressure sores. Abscesses at pressure points can occur if bacteria enter through damaged skin and form localized infections. These require drainage and specific treatment beyond pressure relief. Trauma from cage components, other animals, or external sources may cause wounds that coincidentally occur at pressure points. Skin tumors occasionally develop at sites of chronic irritation. Ischemic necrosis from vascular compromise produces tissue death similar in appearance to severe pressure damage. Self-mutilation sometimes targets areas accessible to the rabbit. Proper diagnosis ensures appropriate treatment.

Potential complications of pressure sores extend beyond local tissue damage. Secondary bacterial infection is common once skin is broken, potentially spreading to involve larger areas or deeper tissues. Osteomyelitis (bone infection) develops when infection reaches underlying bone and is extremely difficult to treat, often requiring prolonged antibiotic therapy or amputation. Sepsis (systemic infection) can result from severe or poorly controlled wound infections. Chronic non-healing wounds may develop, particularly if causative factors cannot be adequately controlled. Fly strike can occur in warm weather if wounds are not properly protected. These serious complications emphasize the importance of aggressive prevention and early intervention for pressure sores.