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Pressure Necrosis in Dogs: Causes, Symptoms & Care

Pressure Necrosis in Dogs: Causes, Symptoms & Care

General Tips

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Owners

Learn about pressure necrosis in dogs, including causes, symptoms, and effective care to protect your pet's health.

By 

Sustainable Vet Group

Updated on

August 13, 2026

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This article is for informational purposes only and is not a substitute for professional veterinary advice. Every case is unique, so always consult your veterinarian for guidance specific to your pet.

This content is intended for veterinary professionals for educational purposes. It does not replace clinical judgment or tailored advice. Always rely on your training, expertise, and the specific context of your patients.

Pressure Necrosis in Dogs: Causes, Symptoms & Care

Pressure necrosis in dogs also called decubital ulcers or bedsores is the progressive death of skin and underlying tissue caused by sustained pressure cutting off blood supply. It follows the same biological mechanism as bedsores in bedridden humans, and it is a real and preventable risk for any dog that spends long periods lying in one position.

The condition is deceptive: it starts as a small area of hair loss and can advance to a deep open wound reaching muscle or bone within days. Recognizing it at Stage 1 is the goal.

 

Quick answer: Pressure necrosis occurs when sustained pressure on bony prominences like elbows and hips cuts off blood flow, killing tissue. It is most common in senior, immobile, or post-surgical dogs. Early signs are hair loss and redness.

 

Key takeaways

  • Prolonged pressure on bony prominences blocks blood flow and causes tissue death from the inside out
  • Senior, large-breed, paralyzed, and post-surgical dogs are at highest risk
  • Common sites include the elbows, hips, hocks, and the outside of the knees
  • Stage 1 (hair loss and redness) is the ideal intervention point; the wound has not yet opened
  • Stage 3 and 4 wounds require surgical debridement and often systemic antibiotics
  • Orthopedic foam bedding plus repositioning every 2 to 4 hours is the most effective prevention combination

What causes pressure necrosis in dogs

Walkin' Pets explains the mechanism clearly: "Decubital ulcers form when repeated pressure on an affected area constricts the blood vessels, decreasing the area's blood supply and as the skin is deprived of oxygen, it begins to die."

This process concentrates at bony prominences where bone is close to the skin surface with little muscle or fat as a buffer. In dogs, the most commonly affected sites are:

  • Elbows the most frequent site, especially in large and giant breeds
  • Lateral hips and hip bones
  • Hocks (the ankle joint of the hind leg)
  • Stifles (outer surface of the knee)
  • Sides of the ribs in dogs that always lie on one side

The damage does not require continuous lying. Ortocanis notes that high pressure over a short period is as damaging as lower pressure sustained over longer periods. A heavy dog that drops onto a hard floor with force can create the same tissue trauma as extended immobility.

Which dogs are most at risk

Any dog can develop pressure necrosis if the conditions are right, but several factors increase risk substantially:

Senior dogs: muscle mass decreases with age, reducing the natural padding over bony prominences. Reduced mobility means longer uninterrupted periods in the same position.

Large and giant breeds: more body weight means greater compressive force at contact points. Dr. Buzby's ToeGrips notes that large breeds are disproportionately affected even when they are healthy and mobile.

Post-surgical patients: strict rest requirements, post-anesthesia sedation, and pain-related reluctance to move all increase time in one position.

Paralyzed or paraplegic dogs: no ability to self-reposition at all. These dogs require active owner repositioning to prevent pressure injury.

Obese dogs: higher body weight amplifies compressive force at every contact point.

Short-coated breeds: less coat means less cushioning between skin and hard surfaces.

For how callus formation at the same pressure sites relates to early pressure damage, see calluses as chronic pressure injuries.

The 4 stages of pressure necrosis

Stage 1: redness and hair loss

The skin over the bony prominence loses hair and becomes pink or red. The area may feel slightly warm but the skin surface is intact. There is no open wound.

What to do: act immediately. Add thick orthopedic padding under the affected area. Increase position changes to every 2 hours. Monitor the site daily. Stage 1 reverses with proper management.

Stage 2: surface skin breakdown

The skin partially breaks down. A shallow blister or open area appears. The wound is painful and the dog will likely lick or chew it, worsening the damage.

What to do: veterinary wound care is needed at this stage. Home management alone is not sufficient. The vet will clean the wound, assess for infection, and prescribe appropriate dressings and possibly antibiotics.

Stage 3: full-thickness wound

The sore extends through the full skin thickness into subcutaneous tissue. WagWalking: "Pressure sores can progress quickly, leading to deep wounds that cause the muscle and bone to become visible."

Infection is common at Stage 3. The wound has discharge and often a foul odor. Bacteria can include Staphylococcus, Pseudomonas, and Enterococcus species.

What to do: aggressive veterinary management including wound debridement, culture-guided antibiotics, and advanced wound dressings.

Stage 4: deep tissue involvement

The wound extends to muscle, tendon, or bone. This is a potentially life-threatening stage. Sepsis (systemic bacterial infection) becomes a risk when deep tissue infection spreads.

What to do: emergency veterinary care. Surgical debridement, hospitalization, IV antibiotics, and possibly reconstructive surgery are required.

Treatment by stage

StageSignsTreatment approach
1Hair loss, redness, intact skinPadding, repositioning, daily monitoring
2Shallow open wound or blisterVet wound care, dressings, possible antibiotics
3Full-thickness wound with dischargeDebridement, culture, systemic antibiotics
4Wound reaches muscle or boneSurgical debridement, hospitalization, possible reconstruction

 

For Stage 1 and 2 home wound care, clean the area gently with dilute chlorhexidine or mild antiseptic solution. Apply a non-adherent wound dressing and change it daily. Do not use hydrogen peroxide, which damages healing tissue. Keep the dog away from hard surfaces at all times until the wound has closed and resolved.

For how bed sores and pressure necrosis overlap and how prevention differs, see bed sores as a related pressure injury.

Prevention: what actually works

Orthopedic bedding

Thick memory foam or egg-crate foam beds distribute body weight more broadly, reducing peak pressure at bony points. The bedding must not fully compress under the dog's weight to be effective. Check the foam by pressing down firmly: if it bottoms out immediately, it offers little protection for a large dog.

Waterproof covers that can be washed frequently are important for dogs at risk of incontinence, which is common in paralyzed patients.

Repositioning schedule

Reposition an immobile dog every 2 to 4 hours, alternating which side bears weight. This mimics the natural unconscious repositioning healthy dogs do throughout the day.

Ortocanis: "This problem occurs mainly in immobile animals: quadriplegic or paraplegic dogs, elderly dogs or those with serious illnesses."

Daily inspection

Check every bony prominence daily. Run your hand over the elbows, hips, hocks, and knees. Hair loss is the first visible sign act at that point rather than waiting for skin breakdown.

Protective wraps and donut pads

Elbow pads and donut-shaped protective wraps can be placed over at-risk sites to prevent direct contact with hard surfaces. These are particularly useful for dogs that regularly rest on hard floors despite having soft bedding available.

For how swelling from pressure injuries can extend into the feet and legs, see swelling associated with pressure injuries.

Frequently asked questions

How do I know if my dog has a pressure sore starting?

The first sign is a patch of hair loss over a bony prominence such as the elbow or hip, sometimes with mild redness. The skin is still intact at this point. Run your hand along these sites daily in at-risk dogs. If you feel a bare or reddened area, increase padding and position changes immediately and monitor closely for any skin breakdown.

My dog is recovering from surgery and lying down constantly. How do I prevent pressure sores?

Reposition every 2 to 4 hours, alternating sides. Use thick orthopedic foam padding rather than thin blankets or bare floors. Check the elbows, hips, and hocks each time you reposition. Ask your vet at discharge whether there are specific at-risk sites based on your dog's size, breed, and surgical procedure.

The skin over my dog's elbow looks bare and red but is not open. Is this a pressure sore?

Yes, this is Stage 1 pressure necrosis. The tissue is under sustained pressure but has not yet broken down. This is exactly the time to act: add thick padding, protect from friction, and monitor daily. If the skin opens, see your vet within 24 to 48 hours.

Can pressure necrosis be fully healed?

Stage 1 and 2 lesions heal well with proper wound care and pressure relief. Stage 3 and 4 wounds can heal but often leave permanent scar tissue, and may involve months of treatment. Full wound closure at advanced stages is not always achievable and managing infection becomes the primary goal.

What is the best bedding to prevent pressure sores?

Thick memory foam or high-density egg-crate foam is most effective. The padding needs to be dense enough not to fully compress under the dog's full weight. Standard flat beds offer minimal protection for large dogs. Waterproof removable covers allow frequent washing, which reduces infection risk at the skin surface.

Can a pressure sore become life-threatening?

Yes. Stage 3 and 4 wounds can allow bacteria to spread from the wound into deeper tissues or the bloodstream, causing sepsis. A dog with a deep infected ulcer that is also lethargic, off food, or running a fever may be systemically ill and needs emergency veterinary care that day.

Resources

  • Dr. Buzby's ToeGrips. Pressure Sores on Dogs: Treatment and Prevention. toegrips.com
  • WagWalking. Pressure Sores in Dogs. wagwalking.com
  • Walkin' Pets. Pressure Sores in Pets: Treatment and Prevention. walkinpets.com
  • Ortocanis. Pressure Ulcers in Convalescent Dogs. ortocanis.com
  • DogCancer.com. Bed Sores on Dogs: Preventing and Treating Pressure Sores. dogcancer.com

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