Grade 3/4 decubitus ulcers are not compatible with life and long-term complications caused by prolonged conservative care for these diagnoses have risks as well
“There is little doubt VAC packs have some role, although ill-defined, in the management of Grade III/IV sacral decubitus ulcers. Clearly, VAC packs are currently overutilized by physicians who don’t have the skills or access to plastic surgeons with the skills for definitive management of large bedsores which is flap closure. Unfortunately, patients are hooked up to VAC packs for months-on-end with no idea that a plastic surgeon can close these wounds with upward of 85% success rate,” states Greg Vigna, MD, JD, wound care expert, and national malpractice attorney.
Dr. Greg Vigna, national malpractice attorney, continues, “The Centers for Medicare and Medicaid Services (CMS) has provided a reimbursement model for Long-Term Acute Care Hospitals that allows these facilities to profit from the comprehensive, interdisciplinary cooperation between physicians with the skills for both conservative and surgical management for the treatment of pressure sores which is designed to optimize outcomes for patients who have suffered from hospital acquired and nursing home acquired decubitus ulcers.”
“Clearly, if a VAC pack is used on a patient more than two to four weeks, it really begs the question if this patient would be best served with surgical closure of the wound with a flap.” — Greg Vigna, M.D., J.D.
Dr. Vigna adds, “Unfortunately, not all LTACs have the surgical specialist and non-surgical specialist to optimize outcomes and work within the payment system created by CMS. It is not uncommon that these patients are admitted with profound malnutrition that they require three to four weeks of nutrition support following surgical debridement to support healing prior to proceeding with flap closure. These patients need time to improve nutritionally and LTACs have time to get patients to a point medically they are ready to have a successful outcome. Using a VAC pack for a short time might be beneficial in situations where drainage is excessive. Clearly, if a VAC pack is used on a patient more than two to four weeks, it really begs the question if this patient would be best served with surgical closure of the wound with a flap.”
Dr. Vigna concludes, “We represent the patients who have suffered Grade 3 and Grade 4 decubitus ulcers. These patients must get to facilities that have the scope of services that allows patients to benefit from all treatment options available that include flap closure. Every surgical procedure has risks but Grade III and Grade IV decubitus ulcers are not compatible with life and the long-term complications caused by prolonged conservative care for these diagnoses have risks as well. Recurrent soft tissue infections, chronic osteomyelitis, resistant bacterial infections, chronic malnutrition from increased metabolic demands of a deep wound, and disuse muscle atrophy from being bed confined for months are not insignificant when compared with the risk of surgeries.”
Learn more from Dr. Vigna and the Decubitus Ulcer Help Desk and information related to decubitus ulcers.
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. Nursing homes and hospitals must be held accountable for the complications they cause. The Vigna Law Group along with Ben C. Martin, Esq., of the Martin Law Group, a Dallas Texas national pharmaceutical injury law firm, including a license to practice law in Pennsylvania, jointly prosecute hospital malpractice and nursing home neglect cases, nationwide.
More on Flaps:
https://www.ncbi.nlm.nih.gov/books/NBK546581/#:~:text=Myocutaneous%20flaps%20are%20compound%20flaps,fascia%2C%20and%20the%20underlying%20muscle.
Pressure Ulcer Trends in the United States: A Cross-Sectional Assessment from 2008-2019:
https://journals.sagepub.com/doi/full/10.1177/00031348231158691
Wounds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950802/
https://www.sciencedirect.com/science/article/abs/pii/S0002961010006860
Greg Vigna, MD, JD
Vigna Law Group
+1 800-761-9206
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