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

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.