I have cared for patients with chronic non-healing wounds for 25 years in the hospital and the outpatient clinic settings. My first experience treating homebound patients occurred during the Fall of 2020 when I created a company called On Call Wound Care. One of my roles at On Call Wound Care is to evaluate and treat patients with chronic wounds who cannot leave their homes or are too ill to be assessed at a wound clinic during the COVID-19 pandemic.

At some of these homes, I noticed a purple, maroon skin discoloration on the buttocks of the patients that sit and spend most hours of the day in a recliner. I followed those patients and noticed that this skin discoloration did not progress into a deeper tissue pressure injury but remained chronically discolored and did not improve unless the patient modified the habit of not sitting on the recliner for hours at a time. I researched the literature and was pleased to see that Mahoney and Rozenboom (2019) described this unique form of purple-maroon discoloration of the buttocks and suggested calling it chronic tissue injury. These authors also noticed the minimal change in the discoloration over time and recommended additional research to understand the histopathology of this phenomenon.

The “recliner butt,” as it is also labeled, is a phenomenon that should be further studied and recognized as a new form of skin injury. Other authors such as Kelechi (2019) and Berke (2019) have brought light to this phenomenon and recommended further research. It is essential to recognize this phenomenon because other clinicians involved in the care of the patient mistakenly describe it as Stage 1 or Stage 2 pressure injury (PI), deep tissue pressure injury (DTPI), skin failure, moisture-associated skin damage or traumatic skin injury.
A consequence of the COVID-19 pandemic is the severe deconditioning and weight increase that many of our patients have experienced. Many of these patients spend every hour of their days in recliners, and it is vital to evaluate their skin and remind them of the importance of standing and ambulating to prevent skin injuries.

Berke, C. (2019). Re: “Definition and Characteristics of Chronic Tissue Injury: A Unique Form of Skin Damage”. J Wound Ostomy Continence Nurs. May/Jun; 46 (6): 553 doi: 10.1097/WON.0000000000000594

Mahoney, M.F. & Rozenboom, B.J. (2019). Definition and Characteristics of Chronic Tissue Injury: A Unique Form of Skin Damage. J Wound Ostomy Continence Nurs. May/Jun; 46 (3): 187-191. doi: 10.1097/WON.0000000000000527.

Kelechi, T.J. (2019). Commentary: Chronic Tissue Injury, J Wound Ostomy Continence Nurs. May/June; 46 (3): 192-193 doi: 10.1097/WON.0000000000000533