Decubitus ulcers are a complex condition that may require medical or surgical treatment. Treatment algorithms vary greatly from non-operative management to more aggressive surgical debridement and myocutaneous flaps for coverage. Fecal diversion is commonly used to aid in both the medical and surgical management of decubitus ulcers. However, the argument that fecal diversion aids in the management of decubitus ulcers remains controversial. A retrospective study was conducted at a single academic institution to determine the benefit of diverting colostomy prior to the surgical treatment of medically refractory decubitus ulcers. Sixty-seven consecutive patients were included in the study. The length of time to healing, recurrence rate, and measures of quality of life were compared between a group of patients who received diverting colostomy prior to surgical therapy for a decubitus ulcer (n=41) versus a control group of patients who did not receive diverting colostomy (n=26). The study group that had fecal diversion with colostomy demonstrated reduced healing time, decreased recurrence rate, and improved quality of life versus the control group. A diverting colostomy should be strongly considered for the management of patients with medically refractory decubitus ulcers.