Stage IV Bedsores

Bedsores are serious wounds caused by sustained pressure.  They usually form over the boney prominences of the body, and are most commonly found on the back, buttocks and heels.  Bedsores are staged from I-IV (1-4) based on the severity and depth of the wound.  Stage 4 represents the worst of these wounds.

A bedsore which has progressed to stage 4 presents a serious, life-threatening condition which is often excruciatingly painful.  These wounds are not “normal,”  and generally do not form if the resident is being properly cared for.   In other words, a stage 4 wound generally results from negligence.  These wounds are difficult to treat and frequently prove to be fatal.  

What is a Stage IV Bedsore?

A stage 4 bedsore is an advanced pressure wound which extends all the way through the skin and muscle, generally exposing the bone.  These catastrophic wounds generally form due to negligence or neglect on the part of a nursing home or other caretaker. As stage 4 bedsores typically present as large open wounds, they present a serious risk of infection.  This is particularly true where the patient is incontinent and the wound is in an area, like the buttocks, which can be infiltrated by feces or other waste materials.  Further, the visible wound may not tell the whole store. Tissue damage from a stage 4 bedsore often extends far beyond the open wound itself and may “tunnel” beneath other “healthy looking” skin surrounding the bedsore.

Stage 4 bedsores are horrific wounds.  They generally appear as a large, gaping holes surrounded by dead and damaged tissue. The wound will extend through the skin, fatty layers and the deeper muscle tissues.  The patient’s muscle, tendons, ligaments, and even bone will generally be visible through the open wound. The skin along the edges of the wound is often black and may even look “rotten”.  “Crusty” areas may also be seen along the edges of the bedsore. Infection is common with stage 4 wounds, and may include localized cellulitis or a systemic infection, such as sepsis.

A person suffering from a stage 4 bedsore needs urgent medical attention.

How is a Stage IV Bedsore Treated?

Stage 4 bedsores are often fatal.  The ability of a patient to recover will largely depend upon their underlying health.  Tragically, most elderly persons are simply not strong enough to recover from a stage 4 bedsore even with the best of care.  When patients present with stage 4 pressure ulcers, treatment is generally directed toward prevention and management of secondary complications, especially sepsis, and the promotion of wound healing.

Typical approaches to treating advanced pressure injuries, such as stage 4 bedsores, include:

• Wound Vac / Negative pressure wound therapy. Negative pressure wound therapy (NPWT), also called vacuum-assisted wound closure, refers to the use of wound dressing systems which use the continuous or intermittent application of sub-atmospheric pressure to the surface of a wound to assist in the healing process. NPWT has become a popular treatment modality for the management of many acute and chronic wounds, including late stage bed sores.  The effectiveness of this form of treatment is highly variable. Medical providers will use a vacuum dressing to enhance and promote wound healing. The therapy involves using a sealed wound dressing attached to a pump to create a negative pressure environment in the wound.
• Debridement. Debridement is a surgical procedure in which the infected and damaged skin and tissues are removed.  The goal of the procedure is to remove all infection and scar tissues down to the deepest level of the wound.  In a stage IV pressure ulcer, this is typically performed by a surgeon, who seeks to remove all necrotic, infected, and nonhealing tissue from the wound base using a scalpel, electrocautery, rongeur, or curette. Tissues removed may include subcutaneous tissue, muscle, tendon, and/or bones. Other means of accomplishing the debridement may include the use of enzymes, ultrasound, and biological debriding procedures.
• Turning & Repositioning. Frequently changing the position of a nursing home resident is a critical feature of both pressure injury treatment and prevention.  Stage 4 wounds typically form because this basic aspect of the care process has been neglected. When an elderly patient is left to sit or lay in one position for extended periods, the tissues bearing the pressure of their weight can be deprived of blood flow and caused to die.  Frequent changes in position alleviate the pressure. For persons already suffering such wounds, turning & repositioning can assist in the healing process and prevent new wounds from forming.
• Powered & Air fluidized Beds. Powered and air-fluidized beds are semi-electric or completely electric hospital support surfaces with integrated powered mattresses.  These mattresses have specially designed surfaces which reduce friction and shear. An “air-fluidized support surface” uses air which is circulated through silicone-coated ceramic beads, creating pressure characteristics similar to fluid. These specialty mattresses are Indicated for patients with stage 3 and 4 pressure ulcers and may be used to prevent the formation of wounds in patients deemed to be “high risk” for wound formation.