Name of the Procedure:

Excision, Sacral Pressure Ulcer, with Primary Suture; with Ostectomy

Summary

Excision of a sacral pressure ulcer involves surgically removing damaged tissue from a pressure sore located at the sacrum (lower spine). This is followed by an ostectomy, which is the removal of bone, and then closing the wound with primary sutures (stitches).

Purpose

The procedure addresses chronic pressure ulcers, which are open wounds resulting from prolonged pressure on the skin. The goals are to remove necrotic (dead) tissue, promote healing, reduce infection risk, and restore the integrity of the skin and underlying structures.

Indications

• Chronic or non-healing sacral pressure ulcers
• Presence of necrotic tissue or bone infection (osteomyelitis)
• Failure of conservative treatment methods (e.g., wound care and antibiotics)
• High risk of infection spread

Preparation

• Patients may need to fast (not eat or drink) for 8-12 hours before the procedure.
• Temporary discontinuation or adjustment of certain medications (e.g., anticoagulants).
• Preoperative assessments including blood tests, wound cultures, and imaging studies.
• Assessment by an anesthesiologist, especially if general anesthesia will be used.

Procedure Description

1. The patient is positioned to expose the sacral area.
2. General or spinal anesthesia is administered to ensure comfort.
3. The surgeon disinfects the area and makes an incision around the ulcer.
4. Necrotic tissue is carefully excised, and an ostectomy is performed to remove any infected or damaged bone.
5. The wound is thoroughly cleaned.
6. The tissue and skin are meticulously closed with primary sutures.
7. A sterile dressing is applied to the closed wound.

Tools and equipment: Scalpel, surgical scissors, bone cutting tools, suturing materials, irrigation devices.

Duration

The procedure typically takes 1-2 hours depending on the extent of the ulcer and bone involvement.

Setting

The procedure is usually performed in a hospital operating room or a surgical center equipped to handle complex surgeries.

Personnel

• Surgeon (typically a plastic surgeon or general surgeon)
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Wound dehiscence (reopening of the wound)
• Anesthesia-related complications
• Scar formation
• Persistent pain or discomfort

Benefits

• Improved healing of the ulcer
• Reduction of infection risk
• Enhanced quality of life due to pain relief and increased mobility
• Prevention of further tissue and bone damage

Recovery

• Patients may need to stay in the hospital for observation for a few days.
• Post-operative care includes regular dressing changes, pain management, and antibiotics.
• Limited physical activity to prevent pressure on the surgical site.
• Follow-up visits with the surgeon for wound assessment and suture removal.
• Complete recovery may take several weeks to a few months.

Alternatives

• Conservative wound care (e.g., dressings, topical treatments)
• Negative pressure wound therapy (vacuum-assisted closure)
• Antibiotic treatment alone if infection is present
• Hyperbaric oxygen therapy
• Pros of alternatives include non-invasiveness; cons may include longer healing time and less effectiveness for severe cases.

Patient Experience

During the procedure, patients are under anesthesia and should not feel pain. Postoperatively, patients might experience discomfort, which can be managed with prescribed analgesics. Following the surgeon's care plan, including wound care and activity restrictions, is essential for a smooth recovery.