back in 1998 i was working in a nursing home who admitted a 27 year old paraplegic who had a huge stage 4 decub. he had the decub for 4 years which was only treated with wet to dry packing. he deveoped vre, became septic, could harldly keep weight on, burned calories and protein like you would not believe. it was obviouse to me that it was never going to heal. i took the initiative to find a plastic surgeon who would see this pt. i put the pt. in my car and took the pt. to the plastic surgeons office (b/c medi-cal and the ltc would not provide transportation). the plastic surgeon to my surprise agreed to do the surgery and had the patient admitted to the university teaching hospital. the surgery was successfull and the patient was able to move out of a nursing home and out on his own.