He fell off a bridge at 25 years old and cannot move his legs. He's had this ulcer for over a year that won't heal. There is hypertrophic granulation tissue at the orifice and a strip of undermining over the sacrum that extends about 10cm, that won't close. In the past we have removed the hypertrophic tissue and were more aggressive with debridements, but that did not seem to make any difference. We can't do cultures but he was empirically treated for osteomyelitis for 6 weeks with clinda without improvement.