No, a Stage 4 wound cannot become a Stage 3 because it involves deeper tissue loss (muscle, tendon, bone) that isn't regenerated; instead, it fills with scar tissue, so it remains classified as a healed Stage 4 or unstageable until fully healed, not downgrade to a less severe stage. While it improves and shallows, the original depth of damage dictates its healed classification, as lost structures aren't fully restored.
Because lost muscle and other structures aren't restored during healing, a Stage IV pressure ulcer can't become a Stage III, II, or I ulcer; it remains a Stage IV ulcer throughout healing. After healing is complete, it should be classified as a healed Stage IV ulcer, not a Stage 0 ulcer.
Stage 4 pressure ulcers can heal on their own, but they are considered open wounds, so they require appropriate care to allow healing and to prevent worsening. Stage 4 pressure ulcers with signs of tunnelling or undermining require longer periods of time to heal.
Full thickness tissue loss extending into underlying tissues such as muscle and possibly bone. Visible or palpable exposed bone, tendon or muscle.
At this stage, the sore has extended through the skin and into deeper tissues, creating an open wound that resembles a deep crater. While it hasn't yet reached muscle or bone, it poses a high risk for infection and requires medical attention to manage and promote healing effectively.
However, the most severe wounds we treat often involve infected ischemic diabetic foot ulcers and stage 4 pressure ulcers, which are also called bedsores. They are the hardest to treat and the ones that also bring the biggest consequences and complications to patients.
Findings from the three models indicate that pressure ulcers in subdermal tissues under bony prominences very likely occur between the first hour and 4 to 6 hours after sustained loading. However, research examining these timeframes in sitting patients is not available.
Stage 4 bedsores are the most severe form of pressure ulcers, extending deep into the muscle, tendon, and even bone. These wounds are not only extremely painful but also put nursing home residents at high risk of fatal infections, including sepsis.
Characterized by severe tissue damage, a stage 4 wound may look like a reddish crater on the skin. Muscles, bones, and/or tendons may also be visible at the bottom of the stage 4 pressure ulcer. Bed sores stage 4 that have become infected may have a foul smell and leak pus.
For healable wounds, it is recommended that moisture-retentive dressings be used on stage 2, 3, and 4 pressure injuries. A range of moisture-retentive dressings have been studied in the literature, and the following benefits identified. Alginate dressings absorb excess wound exudate and keep the wound bed moist.
For stages 3 or 4 bedsores, you might see a wound specialist. Depending on the severity of the pressure ulcer, it may take weeks or months for the sore to heal. To treat a pressure injury, you or your healthcare provider may: Irrigate or clean the wound with soap and water or saline (sterile saltwater solution).
Stage 4: Maturation Stage
It's the longest stage, lasting for up to a year or more depending on the severity of the wound. The cells previously used to repair the wound area are removed through the process of apoptosis (programmed cell death).
Poor Circulation
During the healing process, your body's red blood cells carry new cells to the site to begin rebuilding tissue. Poor blood circulation can slow down this process, making the wound that much longer to heal. Chronic conditions, such as diabetes and obesity, can cause poor blood circulation.
Stage 3 and 4 pressure injuries are wounds that most often need surgical and reconstructive treatment to promote healing. Stage 3 is a wound that extends from the first layer of the skin (epidermis), through the second layer (dermis), and into the fatty tissue below (subcutaneous tissue).
In most cases, the patient will need surgery. This may include a surgical debridement to remove dead tissue. It may also involve a skin graft, which helps close the wound and allows it to heal faster. Some stage 4 pressure sores can take up to two years to thoroughly heal.
The skin is severely damaged and the tissue around it begins to die. This is called tissue necrosis. The bone, muscles or tendons underneath may be damaged. People with grade 4 pressure ulcers have a high risk of developing an infection.
Stage 4: Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.
Stage 4: Remodeling
Also known as wound maturation, remodeling is the last stage of wound healing. It starts in the early weeks of healing and can take a year to complete. Remodeling builds on previous steps to provide long-term healing of the wounded area.
Stage 4: Full-thickness skin loss extends through the fascia with considerable tissue loss. There may be muscle, bone, tendon, or joint involvement. Unstageable: The depth is unknown because slough or eschar obscures the extent of tissue damage.
Symptoms of a pressure ulcer include: discoloured patches of skin that do not change colour when pressed – the patches are usually red on white skin, or purple or blue on black or brown skin. a patch of skin that feels warm, spongy or hard. pain or itchiness in the affected area of skin.
Bedsore complications cause death in about 60,000 people each year. Alarmingly, 50% of nursing home residents in the study who died from pressure sore complications died within six weeks of the pressure sore's appearance. There is a 75% mortality rate for nursing home residents who develop infected pressure sores.
How to know if the sore is healing
However, once a Stage 3 or 4 bedsore develops, the risk of life-threatening complications increases. According to one study involving over 70 patients, “A 180-day mortality rate of 68.9 percent was noted in people who developed . . . full-thickness pressure ulcers, with an average of 47 days from ulcer onset to death.”
The process leading to deep tissue pressure injury precedes the visible signs of purple or maroon skin by about 48 hours. Then about 24 hours later, the epidermis lifts and reveals a dark wound bed. This phase of deep tissue injury evolution is often confused with skin tears.