Pressure Ulcer – Stage IV

Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Pressure ulcer of trochanter – Stage IV; 80% – 90% slough; undermining 3 cm at 10 o’clock; margins with re-epithelialization; edible (rolled edges).

pressure ulcer stage 4

Pressure Ulcer Organizations and Resources

  1. National Pressure Ulcer Advisory Panel (NPUAP)
  2. European Pressure Ulcer Advisory Panel
  3. Agency for Health Care Research and Quality (AHRQ) (formerly AHCPR)
  4. National Guideline Clearinghouse


  1. Hi Laurie, Typo alert- please correct to epibole
    How often do u silver nitrate a rolled edge in a chronic undermined full thickness sacral pressure injury in the LTAC type patient(trach / peg, bedbound, Braden 7, etc…) within the acute care setting?
    Can u point me in the right direction to determine all tissue types that are yellow/white pigment? For example, fibrinous slough, deep dermis, subcutaneous, and the superficial thin yellow tissue that sits in top of a healing wound???
    Thank you!

  2. Looking at the above picture the 80% slough must be just the wound and you are not counting the thick rolled edge?

    Can you suggest other picture sites to learn more about identifying wounds as I am doing a course that requires IDing wounds and they have not really given us many pictures. thx

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