Name of the Procedure:

Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture

Summary

This procedure involves the surgical removal of a pressure ulcer located on the coccyx (tailbone), including the excision of the coccyx itself if necessary. The wound is then closed primarily with sutures.

Purpose

The procedure addresses severe pressure ulcers on the coccyx that have not responded to conservative treatments. The goal is to remove the infected or necrotic tissue, eliminate the source of pressure and discomfort, and promote healing.

Indications

• Persistent and severe pressure ulcers on the coccyx
• Ulcers that have not healed with standard wound care
• Presence of infection or necrosis in the ulcer area
• Chronic pain or discomfort due to the pressure ulcer

Preparation

• Patients may need to fast for 8 hours before the procedure.
• Adjustments in medication, particularly blood thinners, as advised by the surgeon.
• Pre-operative assessments, including blood tests, imaging studies (e.g., X-rays), and a complete physical examination.

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incision: A surgical incision is made around the ulcer.
3. Excision: The pressure ulcer and any necrotic tissue are carefully excised.
4. Coccygectomy: The coccyx is surgically removed if it is contributing to the ulcer or otherwise indicated.
5. Primary Suture: The surgical site is cleaned and closed with sutures.
6. Dressing: A sterile dressing is applied to the wound.

Duration

The procedure generally takes about 1–2 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• A surgical team, including a surgeon specialized in wound care or orthopedics
• An anesthesiologist
• Operating room nurses
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Reaction to anesthesia
• Delayed wound healing
• Scarring
• Recurrence of pressure ulcers
• Damage to surrounding structures

Benefits

• Relief from chronic pain and discomfort
• Prevention of further complications, such as infections
• Improved quality of life
• Enhanced wound healing

Recovery

• Hospital stay for 1–2 days post-surgery
• Pain management with prescribed medications
• Follow-up appointments to monitor healing
• Limited activity for a few weeks to allow proper healing
• Instructions on wound care and possibly physical therapy

Alternatives

• Conservative wound care (dressings, medications, therapeutic mattresses)
• Antibiotics for infection management
• Minimally invasive procedures
• Hyperbaric oxygen therapy

Each alternative has its pros and cons, with surgical excision providing a definitive solution but also carrying surgical risks.

Patient Experience

Patients may experience pain and discomfort immediately after the surgery, which is managed with pain relief medications. During recovery, maintaining proper wound care and following activity restrictions are crucial for healing and comfort.