Quick Answer

Stage 4 is the most severe stage of bedsores. At this stage, the wound has deteriorated tissues all the way down to the bone. These bedsores are dangerous and can destroy muscle, bone, tendons, and joints. Bedsores are usually caused by prolonged pressure on one area of the body or excessive friction.

Medical attention is always needed once bedsores have progressed to stage 4. A doctor should be consulted as soon as possible once a stage 4 bedsore is identified. Treatment can be difficult at this stage and there is a high risk for infection. Stage 4 bedsores should be avoided at all costs. Caretakers can prevent bedsores by performing frequent position changes and skin assessments.

Identifying a Stage 4 Bedsore

In stage 4, bedsores have broken through all layers of skin and fat. Muscle is visible in stage 4 and sometimes these sores extend all the way to the bone. To differentiate stage 4 from stage 3, in stage 3 fat is visible, but muscle and bone are not.

Stage 4 bedsores have broken through many layers of soft tissue, including:

  • The epidermis (outer layer of skin)
  • The dermis (second layer of skin)
  • Subcutaneous tissue (Fatty layer below the skin)

Several other types of tissue may be visible in a stage 4 bedsore, including:

  • Fascia (thin layer of fibrous tissue around a muscle or organ)
  • Muscle
  • Tendon
  • Ligament
  • Cartilage
  • Bone
  • Slough (type of dead tissue that is avascular and discolored)
  • Eschar (dark brown or black dead tissue, visibly similar to a scar)

The depth of these sores depends on the location they develop. An area with a thicker layer of fat offers the opportunity for a deeper wound. For example, a stage 4 bedsores on the nose or ear will be relatively shallow compared to a stage 4 bedsore on the buttocks.

Some severe bedsores are unstageable before treatment. If dead tissue, like slough or eschar, obscure the full depth of the wound, it will be considered unstageable. Once the dead tissue is removed, a process called debridement, doctors can properly stage the bedsore.

Treating Stage 4 Bedsores

Stage 4 bedsores need to be treated by a medical professional as soon as possible. Bedsores that reach stage 4 have become serious and can be life-threatening. This type of wound can be very deep in some cases. They can take anywhere from 3 months to 2 years to heal.

As always, the first step to treating a bedsore is to remove all pressure from the area. After that, more intense treatments can take place. Surgery is often required in stage 4.

One way surgery can be helpful is by removing the dead skin in and around the wound in a process called debridement. Removing the dead skin can help the wound to heal itself. Another form of surgery is called flap reconstruction. In this process, surgeons use a pad of your muscle, skin, or other tissue to cover the wound and cushion the bone.

Pain management is an important part of treating bedsores. At stage 4, bedsores can be extremely painful. A doctor will help decide the best way to treat pain but ibuprofen (Advil), naproxen sodium (Aleve), or topical pain medications may help.

Infections can be a very serious complication and are somewhat common in stage 4. Infections can spread to the blood, heart, and bone, creating a life-threatening situation. Antibiotics may help patients avoid an infection. At this point, bone may be visible in the wound. When bone is visible, it is crucial that doctors check for bone infection, called osteomyelitis.

Other possible complications during treatment include respiratory problems and urinary tract infections (UTIs). These complications happen because patients often need to be less active during the healing process.

Preventing Stage 4 Bedsores

Stage 4 bedsores should be prevented as often as possible. It is estimated that 95% of all bedsores are preventable. Bedsores that are not prevented before stage 1, will hopefully be caught before they progress further.

As bedsores progress, they take longer to heal.  If bedsores are caught at stage one, they may only take a few days to heal. At stage 4, bedsores can take years to heal.

Before bedsores become severe there are several stages of warning signs. Patients at hospitals and residents at nursing homes should be checked regularly for bedsores if they are at high risk. Those at risk should be checked at least daily, preferably more often.

People at risk of developing bedsores have limited mobility for a number of reasons, including:

  • Inability to move on their own
  • Spending a lot of time in bed
  • Mental conditions, such as alzheimer’s disease
  • Paralysis
  • Wheelchair use
  • Trouble controlling bladder or bowels
  • Old age

Stage 4 bedsores can be very difficult to treat but are highly preventable. People at risk should be monitored regularly for signs of developing bedsores. Once a person has developed a bedsore they should be checked as often as possible for signs of their condition worsening and newly developing sores.

Severe Bedsores From Nursing Home Neglect

You may need to take legal action if a loved one has developed stage 4 bedsores while living at a nursing home. Almost all bedsores are preventable and while not all bedsores are a result of neglect, many are, and it is a nursing home’s job to do their best to prevent them.

Bedsores develop for many different reasons, the main reason is lack of movement. In these cases, nursing home attendants may not have moved a resident as often as they should have. In other cases, bedsores can be caused by or be worsened by dehydration or malnutrition. Nursing homes should carefully monitor the health and diet of all of their residents.

Severe bedsores may be a warning sign of neglect or abuse at a nursing home. In cases of improper care, nursing homes should be held responsible for their lack of attentiveness. If you believe your loved one may be the victim of neglect at a nursing home, please contact us for a free case evaluation to learn more about your legal options.