“Providing rehabilitation in patients with stage IV decubitus ulcers on the coccyx, ischium, or sacrum is at best difficult or futile at worst. In patients who desire myocutanteous flap closure, patients under my care, we would out of the bed rehabilitation until after surgical closure of the wound” … Greg Vigna, MD, JD, national wound care attorney.

Dr. Greg Vigna, MD, JD, national decubitus ulcer attorney, and expert in Physical Medicine and Rehabilitation states, “I managed hundreds of patients admitted with large stage IV decubitus ulcers who were transferred to my rehabilitation hospital with potential to gain independence with transfers and walking. If the plan after consultation with the patient is flap closure of the wound, then we would view out-of-the-bed physical therapy and occupational therapy as being inconsistent with the goals of wound care, as preparing the wound for flap closure becomes the primary goal.”

Dr. Vigna explains, “Bed rest will be required for at least four weeks after the flap, and then it takes about another 7-10 days of gradually increasing sitting and close observation of the closed wound. Bed rest is required for all flaps, as there are significant cardiovascular effects and loss of muscle strength that will reverse any positive physiological effects of active rehabilitation before a flap, and the therapy before a flap can be viewed as futile.”

What are the physiological effects of bed rest by Maria Liz Cunha de Oliveira, Ph.D?

“The resting heart rate increases one beat per minute for every two days of rest, with this increase resulting in a shorter diastolic time and shorter systolic ejection time, leaving the heart less able to respond to demands above baseline.

Increased resting heart rate and the response of the heart rate to exercise is known as cardiac deconditioning … after three to four weeks of bed rest, the resting heart rate increases from 11 to 14 beats per minute, while the exercise response rate increases from 30 to 40 beats per minute.

Muscle strength is maintained by frequent contraction tension, and short periods of bed rest are sufficient to cause the loss of muscle loss and strength, at a magnitude of 10 to 15% per week of disuse, and up to 5.5% per day of bed rest.

Nearly half of normal strength is lost through immobilization of three to five weeks; besides the loss of strength, shortening of muscle fibers also occurs.”

Read “Deleterious effects of prolonged bed rest on the body systems of the elderly-a review”, published in Rev. Bras. Geriatr. Gerontol., Rio de Janeiro, 2018; 21(4): 499-505: https://www.scielo.br/j/rbgg/a/9Yy565TwphHg8s5Cw5fBCwf/?format=pdf&lang=en

Dr. Vigna concludes, “Patients with deep stage 3 or stage 4 need access to flap closure because their prognosis is poor as described in the study by Dr. Damioli which revealed that in patients who were not provided a myocutaneous flap for cure with decubitus ulcer related osteomyelitis, there is a risk of 17% risk of death at one year for these patients.”

Read Dr. Damioli’s study: https://journals.sagepub.com/doi/full/10.1177/20499361231196664

Greg Vigna, MD, JD, is a national malpractice attorney and an expert in wound care. He is available for legal consultation for families and patients who have suffered decubitus ulcers because of poor nursing care at hospitals, nursing homes, or assisted living facilities. The Vigna Law Group along with Ben C. Martin, Esq., of the Martin Law Group, a Dallas Texas national pharmaceutical injury law firm, jointly prosecute hospital and nursing home neglect cases that result in bedsores nationwide.

To learn more: https://vignalawgroup.com/decubitus-ulcer-compensation/