Background Treatment of pressure ulcers around the lower part of the backbone and buttocks causes much suffering to those affected in many ways. The definition of pressure ulcers category 3 is full thickness skin loss and can develop extremely deep. Category 4 is full thickness tissue loss and can extend into muscle and/or supporting strucures. Bone/muscle is visible or palpable. District nurses have an important part in leading structured care and are obliged to update themselves on the latest development of ulcer care. Aim To compare the healing of pressure ulcers category 3 and 4 around the lower part of the backbone and the buttocks, in adult men and women. Method The study was a cross-sectional and prospective design with quantitative approach. A comparison of healed ulcers around the lower part of the backbone and the buttocks in adults was carried out in quality registry RiksSår. Results Total people included 57. The average age was 63 years. The number of males comprised 61 percent and women by 39 percent. Pressure ulcers category 4 consisted of 70 percent (n = 40). Treatment with antibiotics decreased after registration in the registry. 20 percent of men had received surgical treatment. The most frequently used dressing was polyurethane foam. Conclusion The results show that more than half were men who had healed ulcers and pressure ulcers were predominantly category 4. The total healing time between pressure ulcers category 3 and 4 differed by 32 weeks. Overall, the study shows that healing of pressure ulcers is a complex work at an advanced level. District nurse's expertise is important to provide adequate and cost-effective care.