15946 Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure

Name of the Procedure:

Excision of Ischial Pressure Ulcer with Ostectomy for Muscle or Myocutaneous Flap or Skin Graft Closure

Summary

This surgical procedure involves removing a pressure ulcer located on the ischial tuberosity, including the removal of underlying bone (ostectomy). This prepares the wound site for closure using a muscle or myocutaneous flap or a skin graft.

Purpose

The procedure addresses chronic or severe pressure ulcers on the ischial area (buttocks). The goals are to eliminate dead tissue and infection, promote healing, and prevent recurrence by closing the wound with healthy tissue.

Indications

• Chronic non-healing pressure ulcers
• Severe infection or necrosis in the pressure ulcer
• Prevention of further complications such as osteomyelitis
• Patients with adequate overall health to undergo surgery

Preparation

• Fasting for 8 hours before the procedure
• Stopping certain medications (e.g., blood thinners)
• Pre-surgical assessment including blood tests, imaging (e.g., MRI), and possibly nutritional evaluation

Procedure Description

1. The patient is placed under general anesthesia.
2. The area around the pressure ulcer is disinfected.
3. The surgeon excises the ulcer, removing all necrotic tissue.
4. An ostectomy is performed to remove any infected or protruding bone.
5. The wound is prepared for closure using either a muscle or myocutaneous flap or a skin graft.
6. The healthy tissue is contoured and sutured over the wound site.
7. Drainage tubes may be placed to prevent fluid accumulation.

Duration

The procedure typically takes 2-4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon (typically a plastic or reconstructive surgeon)
• Surgical nurses
• Anesthesiologist
• Possibly a wound care specialist

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Anesthesia complications
• Non-healing or recurrence of the ulcer
• Damage to surrounding tissues

Benefits

• Removal of diseased tissue and bone
• Promoted healing and reduced infection risks
• Improved quality of life and decreased discomfort
• Lower risk of ulcer recurrence when healed correctly

Recovery

• Hospital stay for monitoring (usually 5-7 days)
• Instructions for wound care at home
• Physical therapy may be necessary
• Restrictions on sitting and certain activities for weeks to months
• Follow-up appointments for evaluation and possibly additional treatments

Alternatives

• Conservative management (e.g., wound care, antibiotics, pressure relief)
• Hyperbaric oxygen therapy
• Negative pressure wound therapy
• Pros: Less invasive than surgery
• Cons: May not be effective for severe cases

Patient Experience

Patients will be under general anesthesia during the procedure, so they will not feel pain. Post-operative discomfort will be managed with pain medications. Initial recovery may involve discomfort from the wound and restricted mobility. Patients should follow care instructions closely to promote proper healing and prevent complications.