Management of pressure injuries with associated osteomyelitis in people with spinal cord injury: a national survey of referral centers in France

TL;DR

This study explores how French hospitals manage pressure injuries with osteomyelitis in spinal cord injury patients, highlighting inconsistent practices and the need for standardized care.

Contribution

The paper provides insights into current management variability and highlights the need for evidence-based protocols in treating pressure injuries with osteomyelitis.

Findings

Surgical techniques and antibiotic protocols varied significantly among French referral centers.

Prolonged immobility was linked to complications like thromboembolism and malnutrition.

Cure rates ranged from 70–90%, indicating potential for improved standardized care.

Abstract

Pressure injuries are common among individuals with spinal cord injury and often complicated by superinfection, leading to sepsis, hospitalizations, and significant healthcare costs. Osteomyelitis associated with pressure injuries poses diagnostic challenges and requires effective medical and surgical management. To investigate current practices, a national survey of French centers managing over 20 cases annually was conducted. Results revealed significant variability in surgical techniques, antibiotic protocols, and people care pathways. Musculocutaneous and perforator flaps were commonly used, but their application differed among centers. No flaps were performed during acute infections due to failure risks. Bedridden periods and hip flexion protocols varied, with prolonged immobility linked to complications such as thromboembolism and malnutrition. Antibiotic durations ranged from 5–180 days, reflecting differing approaches to infection management. Cure rates within one year ranged from 70–90%. These findings underscore the need for standardized, evidence-based protocols to optimize care for this vulnerable population.