Characterized by severe tissue damage, a stage 4 pressure ulcer 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. When infected, bed sores stage 4 may have a foul smell and leak pus.
It can take anywhere from three months to two years for a stage 4 bedsore to properly heal. In some cases, if the damage is too great, a stage 4 bedsore might never heal completely.
Stage 3. These sores have gone through the second layer of skin into the fat tissue. Symptoms: The sore looks like a crater and may have a bad odor. It may show signs of infection: red edges, pus, odor, heat, and/or drainage.
Grade 3 or 4 pressure ulcers can develop quickly. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just 1 or 2 hours. However, in some cases, the damage will only become apparent a few days after the injury has occurred.
In stage 4, full-thickness skin and tissue loss has occurred, with exposed fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. Rolled wound edges (epibole) and eschar may be present. Undermining and/or tunnelling can often occur (for more information on these conditions click here).
With proper medical care, stage 4 bedsore life expectancy is several months or years. However, without specialized medical care, blisters that have advanced through the stages of pressure sores to stage 4 are more likely to cause complications or even death.
Mottling of skin before death is common and usually occurs during the final week of life, although in some cases it can occur earlier. Mottling is caused by the heart no longer being able to pump blood effectively. Because of this, blood pressure drops, causing extremities to feel cool to the touch.
Remodeling or also known as maturation phase is the fourth and final phase in wound healing and lasts from 21 days up to 2 years. In this final and longest phase, collagen synthesis is ongoing in order to strengthen the tissue. Remodeling occurs as wound continues to contract and fibers are being reorganized.
Healthy granulation tissue is pink in colour and is an indicator of healing. Unhealthy granulation is dark red in colour, often bleeds on contact, and may indicate the presence of wound infection. Such wounds should be cultured and treated in the light of microbiological results.
Instead, the full-thickness ulcer is filled with scar tissue composed primarily of endothelial cells, fibroblasts, collagen, and extracellular matrix. A Stage IV pressure ulcer, therefore, can't become a Stage III, Stage II, or subsequently Stage I pressure ulcer.
Phase 2: Inflammation
This phase can be the most painful of all. It is often when you'll notice some reddening, heat and pain as your blood rushes to the wound to clean it. Inflammation generally takes up to six days and should go away.
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).
Age-related differences in wound healing have been clearly documented. Although the elderly can heal most wounds, they have a slower healing process, and all phases of wound healing are affected. The inflammatory response is decreased or delayed, as is the proliferative response.
Of those with Stage 4 bedsores, mortality rates can climb up to 70% within 180 days of onset.
Bedsores that have gotten to stage 4 are severe and life threatening. Data shows the mortality rate for people with stage 4 bedsores is up to 70%. Many of these patients die within 180 days of diagnosis.
Once a pressure ulcer is “staged” it can progress to a higher stage but can NEVER be “BACK-STAGED REVERSE STAGED or DOWN STAGED”. Example: A Stage 3 pressure ulcer can worsen and become a Stage 4 but it NEVER becomes a Stage 2 as it heals.
Class 4 wounds are considered to be dirty-infected. These wounds typically result from improperly cared for traumatic wounds. Class 4 wounds demonstrate devitalized tissue, and they most commonly result from microorganisms present in perforated viscera or the operative field.
The area near the minor skin breakdown becomes bright red, swollen or painful. There is odor coming from the open skin. The drainage from the open skin becomes yellow or green in color.
The blood pressure slowly drops and blood flow throughout the body slows, causing one's extremities to begin to feel cold to the touch. Mottled skin before death presents as a red or purple marbled appearance. It is most often first seen in the feet, from where it then travels up the legs.
Some people have a burst of energy in the 24 hours before they die, sitting up and talking normally for a short period. Often, people's skin colour changes in the days before death as the blood circulation declines. They can become paler or greyer or their skin can become mottled.
When a Kennedy ulcer appears, it can signify your loved one is in their last days or hours of life. These ulcers occur during the dying process as a symptom of skin failure in areas not receiving enough blood and oxygen. They occur suddenly on the skin in the shape of a pear and are likely purple or black.