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Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings
Published on: December 4, 2021
Medico-legal aspects of pressure sores
Axel Heinemann1, Michael Tsokos, Klaus Püschel
1Institute of Legal Medicine, University of Hamburg, Butenfeld 34, D 22529 Hamburg, Germany. heinemann@uke.uni-hamburg.de
Abstract:
Forensic pathologists are increasingly confronted with the need of expertises, which refer to neglected prevention of pressure sores in cases of suspected malpractice. In Hamburg, Germany, a monitoring system for advanced grade decubitus was established by use of routine post mortem examinations before cremation. The trend of decubitus prevalence turned out to be correlated with a local nursery-related quality improvement programme demonstrating the impact of care factors. However, forensic expertise in individual cases must balance very carefully if a fatal decubitus disease was predominantly care-related. A study on nine fatalities with advanced grade decubitus failed to show an increase of Procalcitonin (PCT) as a marker for septicemia. A suppurative osteomyelitis was found in only nine of 20 cases with grade IV decubitus. Even if there is proof for septicemia, the causality must be ensured to be truly decubitus-related.
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