“Dr. Herbert Conway, plastic surgery, wrote about his experience with 1,000 cases of sacral, ischial, and trochanteric decubitus ulcer providing care for paralyzed Veterans at the Veterans Hospital, Bronx, New York. Flap closure provided superior outcomes when compared with conservative management,” states Greg Vigna, MD, JD, national decubitus ulcer attorney.
What did Dr. Herbert Conway report in “Plastic Surgery for Closure of Decubitus Ulcers in Patients with Paraplegia,” published in the American Journal of Surgery, Volume 91, June, 1956?
“Surgery was the most satisfactory form of treatment … The principles of surgical treatment found to be most successful were excision of the ulcer … radical removal of the underlying bone … fascia or muscle flap to cover bone stumps and fill dead space … coverage with a large regional pedicle flap of skin and fat … Using this technic, the success of surgery … increased to 97 percent for ischial … 86% for trochanteric … 84 percent for sacral … recurrence rate from surgery was 3 percent for ischial ulcers, 6 percent for trochanteric … and 11 percent for sacral ulcers.”
To learn more about Dr. Conway’s experience: https://www.sciencedirect.com/science/article/pii/0002961056903270
Dr. Greg Vigna, wound care expert and national decubitus ulcer attorney states, “The standard of care for management of deep Stage 3 and Stage IV decubitus ulcers will always be reliable pressure reliefs, reliable nutrition, surgical debridement of nonviable tissue, and flap closure when there is evidence of granulation tissue. Long-term outcomes support this treatment plan when compared to conservative or palliative care.”
Dr. Vigna continues, “Long-Term Acute Care Hospitals (LTACs) is a licensure that provides a favorable payment scheme for patients who require prolonged hospitalizations because of complex wounds. Unfortunately, not all Long-Term Acute Care Hospitals have plastic surgeons on staff.”
Dr. Vigna concludes, “Patients with serious bedsores need to be referred to LTACs who offer this treatment option otherwise they are put into the conservative management group which places them at significant risk of death and osteomyelitis.”
To learn more about outcomes of flap versus conservative management of decubitus ulcers: 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 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.
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