Early reconstructive surgery has always been the standard of care for the management of deep stage 3 and stage 4 pressure injuries after medical optimization to prevent complications caused by chronic infection and septic shock. Since the 1950s myocutaneous flap surgery by plastic surgeons have saved thousands of patients from complications that include chronic osteomyelitis, malnutrition, and septic shock.
Over the past 10-years there has been a growing body of evidence to support what was known in the medical community that the risk versus benefits of early reconstructive surgery is favored compared to conservative wound care given the substantial risks of recurrent hospitalizations for complications caused by wound related complications and death.
What is the prognosis for a patient with a pelvic Stage IV decubitus ulcer complicated by osteomyelitis?
“Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died.
Among patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping, outcomes were generally poor regardless of treatment, and not significantly improved with prolonged antibiotics”[1]
What does Harvard plastic surgeons say about the surgical treatment of decubitus ulcers?
“Despite patients with poor. Baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.”[2]
What are the Wound Healing Society Guidelines 2023 update say about flaps for cure?
“Preamble: Surgical treatment of pressure injury/ulcers is often considered to be a final invasive choice for wounds refractory to less aggressive care or for use when rapid closure is indicated, however, recent literature suggests that surgery can and should be performed safely in properly selected patients”[3]
To learn more: Read Dr. Vigna’s Book Beneath the Surface: A Legal Perspective on Decubitus Ulcers and Patient Advocacy: https://injurycaresolutionsgroup.com/publication/decubitus-ulcers/
[1] Damioli, et al. Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes. Therapeutic Advances in Infectious Disease. September 6, 2023.
[2] Tran, et al. National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program. Arch Plast Surg 2018; 45(05): 418-424.
[3] Gould, et al. WHS guidelines for the treatment of pressure ulcers-2023. Wound Repair and Regeneration. Vol. 32, Issue 1, pg. 6-33
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