15951 Excision, trochanteric pressure ulcer, with primary suture; with ostectomy

Name of the Procedure:

Excision of Trochanteric Pressure Ulcer with Primary Suture and Ostectomy

Summary

This procedure involves surgically removing a pressure ulcer located over the greater trochanter (the part of the thigh bone near the hip), followed by closing the wound with stitches. Additionally, it includes ostectomy, where a portion of the bone is removed to prevent ulcer recurrence.

Purpose

The procedure addresses severe pressure ulcers that have not healed with conservative treatment. The goals are to remove the ulcerated tissue, prevent infection, promote healing, and reduce the risk of the ulcer returning.

Indications

• Chronic, non-healing pressure ulcers over the hip bone
• Presence of infected ulcers leading to systemic issues
• Severe tissue damage and exposure of the bone
• Failure of other treatments like wound care and antibiotic therapy

Preparation

• Patients may be instructed to fast for 8-12 hours before the procedure.
• Adjustments or cessation of certain medications, such as blood thinners.
• Pre-operative tests including blood work, imaging studies (e.g., X-ray, MRI), and a physical examination.

Procedure Description

1. The patient is administered general or regional anesthesia.
2. The affected area is cleaned and sterilized.
3. An incision is made around the pressure ulcer to remove all dead and infected tissue.
4. An ostectomy is carried out to remove the underlying bone segment.
5. The remaining healthy tissue is then brought together, and the wound is closed with primary sutures.
6. A sterile dressing is applied to the area.

Tools: Scalpel, suturing kit, bone saw, and surgical dressing materials.

Duration

The procedure typically takes 1-3 hours, depending on the severity and size of the ulcer and the complexity of the ostectomy.

Setting

This surgery is usually performed in a hospital or surgical center with appropriate facilities.

Personnel

• Orthopedic or general surgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologist

Risks and Complications

• Infection
• Bleeding
• Reaction to anesthesia
• Nerve or tissue damage
• Recurrence of the pressure ulcer
• Delayed wound healing

Benefits

• Removal of infected and necrotic tissue
• Reduction in pain and discomfort
• Lowered risk of systemic infection
• Improved mobility and quality of life

Benefits can often be realized within weeks post-surgery, pending proper wound care and recovery.

Recovery

• Post-procedure, patients may spend a few days in the hospital.
• Instructions typically include keeping the area clean and dry.
• Avoiding pressure on the affected area.
• Regular follow-up appointments to monitor healing.
• Physical therapy may be recommended.

Recovery time can range from several weeks to a few months.

Alternatives

• Conservative management: Dressing changes, antibiotics, negative pressure wound therapy.
• Less invasive surgical options: Debridement without ostectomy.
• Pros and cons: Conservative management has lower immediate risks but may not always be effective in severe cases.

Patient Experience

During the procedure, the patient will be under anesthesia and not feel pain. Post-surgery, some discomfort or pain can be managed with prescribed pain medications. Patients might experience limited mobility initially and require assistance with daily activities. Pain and discomfort generally improve as healing progresses.