15945 Excision, ischial pressure ulcer, with skin flap closure; with ostectomy

Name of the Procedure:

Excision of Ischial Pressure Ulcer with Skin Flap Closure and Ostectomy

Summary

This procedure involves the surgical removal of a pressure ulcer located on the ischial bone (part of the pelvis). The wound is then closed using a skin flap, and part of the underlying bone (ostectomy) may be removed to promote healing and prevent recurrence.

Purpose

The procedure addresses chronic, non-healing pressure ulcers on the ischial bone, commonly seen in bedridden patients. The goals are to remove infected or necrotic tissue, reduce the risk of infection, and promote healing by using healthy skin to cover the ulcer.

Indications

• Chronic, non-healing pressure ulcers in the ischial region.
• Presence of infection or dead tissue.
• Failure of conservative treatments (e.g., wound care, antibiotics).
• Patients with adequate blood supply and healthy tissue around the ulcer.

Preparation

• Patients are generally required to fast for 8-12 hours before surgery.
• Adjustments to medications, particularly blood thinners, as advised by a physician.
• Preoperative assessments including blood tests, imaging studies, and possibly a cardiac evaluation.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision & Excision: An incision is made around the ulcer, and the necrotic tissue is excised.
3. Ostectomy: Diseased or excess bone is carefully removed to prevent future ulcers.
4. Skin Flap Preparation: A skin flap, consisting of healthy skin and underlying tissue, is prepared and carefully moved to cover the excised area.
5. Closure: The flap is sutured in place, ensuring good blood supply to promote healing.
6. Dressing: Sterile dressings are applied to protect the surgical site.

Duration

The procedure typically takes 2-4 hours, depending on the size and complexity of the ulcer and flap.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon (typically a plastic or general surgeon)
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Flap failure or necrosis
• Deep vein thrombosis
• Anesthesia-related risks
• Prolonged healing time

Benefits

• Removal of infected or dead tissue promotes healing.
• Decreased risk of further complications from the ulcer.
• Improved quality of life due to reduced pain and discomfort.

Recovery

• Patients may stay in the hospital for 1-2 weeks for initial recovery.
• Wound care instructions, including how to change dressings and signs of infection.
• Physical therapy may be necessary to improve mobility.
• Follow-up appointments for monitoring healing progress.
• Restrictions on weight-bearing activities for several weeks.

Alternatives

• Conservative management with wound care and antibiotics.
• Negative pressure wound therapy.
• Less invasive surgical interventions if appropriate.

Patient Experience

• Postoperative pain managed with medication.
• A hospital stay may involve bed rest and limited movement.
• Gradual return to normal activities as healing progresses.
• Emphasis on repositioning to prevent new pressure ulcers from forming.