Poor outcomes for decubitus-related osteomyelitis patients without myocutaneous flapping.
“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.”… Laura Damioli, MD. Therapeutic Advance in Infectious Disease. Volume 10, pg. 1-9. 2023.
Greg Vigna, MD, JD, national decubitus ulcer attorney explains, “Dr. Damioli supports my opinion that I held twenty-four years ago when I developed a flap program at a Long-Term Acute Care Hospital (LTAC) in Northern Louisiana that patients with deep Stage 3 and Stage 4 decubitus ulcer are at substantial risk of death. Patients with these serious hospital or nursing home acquired injuries have a narrow window of time to be saved with curative reconstructive surgery as these medical conditions are not compatible with life.”
What did Dr. Damioli’s study reveal?
- “We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage.
- Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died.
- We found no significant differences in readmission, readmission related to osteomyelitis, subsequent sepsis, or death by treatment group.”
Dr. Vigna continues, “I have known for two decades that there are many LTACs that advertise that they are a ‘specialized wound care program’ only to provide ineffective care for patients with serious bedsores because they didn’t have a physician on medical staff that could provide myocutaneous flaps which is curative for serious bedsores. Many LTACs are simply providing nursing home level care at hospital prices, with no actual long-term benefit to patients with deep Stage 3 or Stage 4 decubitus ulcers.”
“There is no reliable evidence that VAC packs used alone or with IV antibiotics decrease the risk of long-term osteomyelitis or death in patients with deep Stage 3 and Stage 4 wounds.” — Greg Vigna, MD, JD
Dr. Vigna continues, “Plastic surgeons are necessary for patients to receive a meaningful consultation regarding the pros and cons of reconstructive surgery versus conservative options. LTACs without this capability should not be in a position to decide what care a patient with a deep Stage 3 or Stage 4 bedsore receives as they can’t deliver all the treatment options, and the treatments they can provide are ineffective. As a former medical director of a comprehensive wound care program that provides flaps for cure, I was able to have honest conversations with families about prognosis and speak frankly as to the highly invasive procedures that are often necessary for cure. Many of my patients elected for conservative care, while others were cured with flaps. Others were discharged to hospice. The injured deserve all the options and not be steered toward ineffective treatments.”
Dr. Vigna concludes, “My experience with VAC packs with deep Stage 3 or Stage 4 decubitus ulcers is consistent with the literature that this modality works to decrease the size of wounds to prepare the wound for definitive reconstruction with skin grafts or flaps. There is no reliable evidence that VAC packs used alone or with IV antibiotics decrease the risk of long-term osteomyelitis or death in patients with deep Stage 3 and Stage 4 wounds. Dr. Damioli’s study should put all LTACs that don’t offer reconstruction on notice that they must do better and offer hospital quality value for those who are injured.”
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 due to 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.
Greg Vigna, MD, JD
Vigna Law Group
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