A Stage III or Stage IV ulcer has not responded to conventional treatment for six or more weeks.

Your patient has a Stage III or Stage IV ulcer over bony prominences.

You have identified a Stage II or Stage IV ischial ulcer and the patient is non-ambulatory.

A wound with eschar is too thick for effective enzymatic debridement.

Your patient has a wound that has undermining, tunneling and/or cliff edges.

A wound with cellulitis is at high risk for sepsis.