Name of the Procedure:

Excision, sacral pressure ulcer, with primary suture

Summary

This procedure involves the surgical removal (excision) of a pressure ulcer located in the sacral region (lower back near the tailbone). The excised area is then closed with primary sutures to promote healing.

Purpose

The procedure addresses chronic pressure ulcers that have not responded to less invasive treatments. Its goals are to remove damaged tissue, reduce infection risk, and promote healing.

Indications

• Chronic pressure ulcer in the sacral area that persists despite conventional medical treatment
• Presence of infection or necrosis
• Patient with adequate nutrition and health to undergo surgery
• No severe comorbidities that contraindicate surgery

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Any anticoagulant medications may need to be paused.
• Preoperative tests like blood tests and imaging studies (e.g., MRI) to assess the extent of the ulcer and any underlying issues.

Procedure Description

1. The patient is positioned to access the sacral area.
2. Anesthesia (general or regional) is administered to ensure patient comfort.
3. The ulcerated area is cleaned and prepped with antiseptic.
4. The surgeon excises the ulcer, removing all damaged and infected tissue.
5. Surrounding healthy tissue is mobilized, and primary sutures are used to close the wound.
6. A dressing is applied to protect the area.

Duration

Approximately 1 to 3 hours, depending on the ulcer's size and complexity.

Setting

Typically performed in a hospital operating room.

Personnel

• Surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Poor wound healing or dehiscence (wound reopening)
• Anesthesia-related complications
• Recurrence of pressure ulcer

Benefits

• Removal of damaged and infected tissue
• Reduced risk of further infection
• Enhanced healing
• Improved quality of life and ability to participate in rehabilitation

Recovery

• Patients may need to stay in the hospital for a few days for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care and how to avoid pressure ulcers.
• Restrictions on activities that may stress the surgical site.
• Follow-up appointments for wound inspection and suture removal.

Alternatives

• Conservative treatments like wound dressings, debridement, and negative pressure wound therapy.
• Benefits of alternatives include non-surgical nature but may be less effective for chronic or severe ulcers.
• Cons include prolonged healing time and higher risk of complications like infection.

Patient Experience

• Patients may feel pain and discomfort at the surgical site, which is managed with medication.
• A period of immobility to protect the healing area.
• Regular check-ups and dressing changes may be required.
• Emphasis on proper nutrition and repositioning to prevent ulcer recurrence.