October 22, 2017

Decubitus Ulcer Stage 4

Decubitus ulcer stage 4 refers to the severity of a wound that affects the skin and tissue.  Decubitus ulcers, also known as “pressure sores” or “bedsores” are an injury to the skin that develop due to unrelieved pressure applied to the skin, usually over a bony prominence such as an ankle, heel, buttocks, elbows, and hips.  .   The staging of decubitus ulcers provides a standardize means to characterize the skin wound that has developed.  The guidelines for staging decubitus ulcers have been set forth by the National Pressure Ulcer Advisory Panel and are the consensus for staging.  Decubitus ulcers are characterized in stages by their severity, ranging from stage 1, mild skin redness, to stage 4, severe tissue damage.  Decubitus ulcers can begin quickly and progress to an advanced stage in very little time.  Once a wound has progressed to a stage 4 decubitus ulcer, healing can be difficult.

Stage 4 Characteristics

A Decubitus Ulcer – Stage 4  is the most serious type of pressure ulcer.  The severe damage to the skin and tissue creates a wound which extends into the muscle and in some instances can be present all the way to the bone.  Usually dead tissue and drainage are present. Infection can occur easily at this stage.

  • • Full thickness tissue loss with with exposed bone, tendon, or muscle.
  • • Slough, eschar, or necrotic tissue can be present on some parts of ulcer.
  • • Often undermining & tunneling present.
  • • The depth of a Stage IV pressure ulcer varies by anatomical location.  The bridge of the nose, ear, occiput and and malleoulus do not have subcutaneous tissue and the se ulcer can be shallow.


Treating Decubitus Ulcers at Stage 4

A Decubitus ulcer stage 4 has progressed to a point where treatment and healing may be difficult and will be slow.   Wounds in this stage often need specialized wound care with cleaning and debriding agents, and surgery is frequently required.  Common treatment of a decubitus ulcer – stage 4  include:

  • • an overall assessment of the patient’s health, taking into account their ability to reposition themselves, their mental awareness, and their nutritional needs
  • • frequent position changes and the use of pressure reliving devices
  • • cleansing of the wound with water or saline
  • • debridement of the wound (removal of the devitalized tissue from a wound)
  • • application of topical dressings
  • • surgery

Decubitus Ulcers can be prevented with proper nursing care.

Because nursing home and hospital patients are often confined to a bed or wheelchair, they are often at higher risk for developing decubitus ulcers.   Therefore, nursing homes and hospitals are required to provide these patients with special nursing interventions to ensure that they are protected from developing these wounds. It is generally no longer acceptable for hospitals and nursing homes to allow their patients to develop pressure ulcers, especially those which become advanced.  State and federal nursing home regulations require that that nursing homes must ensure that a patient who enters a nursing home without a decubitus ulcer does not develop a decubitus ulcer unless they are clinically unavoidable.  Likewise, Medicare will no longer reimburse hospitals for medical bills associated with advanced pressure sores that develop while the patient is admitted to the  hospital.

Unfortunately however, published studies have found a prevalence of pressure sores  in excess of 25% of patients in hospital and nursing home settings.*

Nursing negligence causes decubitus ulcers.

Our firm has recovered substantial sums on behalf of patients who developed decubitus ulcers / pressure ulcers.   We believe these recoveries have been obtained for two primary reasons:

(1) pressure sores are painful and life-threatening injuries, and

(2)  in most all cases, pressure sores are preventable if proper care is provided.

Healthcare providers must follow basic safety rules to protect patients from decubitus ulcers.  Early recognition of the signs of skin breakdown  is critical, because pressure sores are much easier to prevent than they are to heal.  Once a decubitus ulcer becomes advance, it  often becomes infected, and can lead to sepsis and even death. Nursing home and hospital nursing personnel must ensure  timely and diligent skin inspections, frequent turning and repositioning, the use of proper pressure relieving devices for the bed and wheelchair, proper attention to the patient’s hydration and nutrition, and other nursing measures depending upon the individual patient’s needs.  When these patient safety rules are ignored,  patients are put at significant, and unnecessary risk of developing pressure sores.

Why you should not delay in consulting an attorney.

The development of pressure sores are typically the result of nursing malpractice.  Indiana law imposes strict deadlines (also called “statutes of limitations”) in medical malpractice cases that will forever bar the claim if it is not filed in a timely manner.  The law relating to the deadline can be exceedingly complex; therefore, one should not delay in consulting a qualified medical malpractice attorney to determine the applicable statute of limitations and review the case.

How to obtain a free case evaluation today.

If you or a loved one developed a pressure sore in a nursing home or hospital, The Powless Law Firm, P.C. would like to help.  You can request a free case consultation today by calling us at 877-769-5377 or by submitting the free case consultation request form on this page.

Here is important information you should know about us:

  • • We concentrate upon medical malpractice and nursing home neglect claims only, and have years of experience and success in doing so.
  • • We offer free consultations, without any obligation.
  • • We never require any retainer fee.
  • • We accept cases on a contingency basis, meaning we only get paid if we obtain a recovery for you.
  • • We accept cases anywhere in Indiana.
  • • We work with a variety of highly qualified medical experts to thoroughly evaluate and present our cases.
  • • We are committed to providing the attention and resources required in these complex cases to help make a difference for those harmed by medical malpractice, and to help force changes that will help protect others.
  • • We never represent the negligent hospitals, nursing homes, healthcare providers or their insurers.

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*See these two studies:

  • Cuddigan J, Ayello EA, Sussman C, eds.  Pressure ulcers in America: Prevalence, incidence, and implications for the future.  2001.  Reston, VA:  National Pressure Ulcer Advisory Panel.
  • Horn SD, Bender SA, Fergusson MI, et al.  The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents.  J Am Geriatr Soc 2004; 52(3): 359-367.


For more information and resources about pressure sores.: www.pressure-sores.com

National Pressure Ulcer Advisory Panel:  www.npuap.org/

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