Name of the Procedure:

Excision of Sacral Pressure Ulcer in Preparation for Muscle or Myocutaneous Flap or Skin Graft Closure

Summary

This procedure involves removing damaged tissue from a pressure ulcer located over the sacral area (lower back) to prepare the wound for further closure using either a muscle or myocutaneous flap, or a skin graft. The goal is to remove all necrotic (dead) tissue and create a healthy bed for the graft or flap to promote better healing.

Purpose

This procedure addresses sacral pressure ulcers, which are wounds that develop due to prolonged pressure on the sacral area. The main goal is to excise all non-viable tissue, reduce infection risk, and prepare the site for effective closure to promote healing and prevent further complications.

Indications

• Presence of a non-healing sacral pressure ulcer.
• Ulcer grade III or IV (extending to muscle or bone).
• Persistent infection or necrosis despite conservative treatment.
• Situations where simpler wound care methods have failed.
• Adequate health status to tolerate surgical intervention.

Preparation

• Patients may need to fast for a certain period before the surgery.
• Preoperative assessment including blood tests, imaging studies, and possibly a wound culture.
• Adjustments to medications, especially anticoagulants, as advised by the healthcare provider.
• Plan postoperative care, which might include a discussion about potential rehabilitation needs.

Procedure Description

1. Anesthesia: General or regional anesthesia will be administered.
2. Positioning: The patient is positioned to provide optimal access to the sacral area.
3. Excision: Using surgical instruments, the surgeon excises the ulcer, removing all necrotic and infected tissue, ensuring margins are clear of non-viable tissue.
4. Irrigation: The wound bed is thoroughly irrigated to clean out debris and bacteria.
5. Hemostasis: Bleeding is controlled using cautery or other hemostatic agents.
6. Preparation for Closure: The wound is prepared for closure, whether by muscle/myocutaneous flap or a skin graft, which may be performed in the same surgical session or a subsequent one.
7. Dressing: The wound is dressed with appropriate surgical dressings.

Tools and equipment may include scalpels, scissors, cautery devices, irrigation systems, and surgical dressings.

Duration

The procedure typically takes 1 to 3 hours, depending on the extent of the ulcer and the complexity of the excision.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon specialized in wound care or reconstructive surgery.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and possibly a wound care specialist.

Risks and Complications

• Infection at the surgical site.
• Bleeding.
• Reaction to anesthesia.
• Delayed wound healing or non-healing.
• Damage to surrounding tissues.
• Need for additional surgeries.

Benefits

• Removal of necrotic tissue reduces infection risk.
• Creates a viable wound bed for further closure.
• Increases the chances of effective healing and recovery.
• Reduces the likelihood of further complications associated with chronic pressure ulcers.

Recovery

• Patients may need to continue with specific wound care and dressings.
• Pain management, typically with prescribed pain medications.
• Close monitoring for signs of infection or complications.
• Physical therapy may be recommended to prevent further pressure ulcer development.
• Regular follow-up appointments to monitor healing progress.

Alternatives

• Conservative wound care (dressings, topical treatments).
• Negative pressure wound therapy (wound VAC).
• Hyperbaric oxygen therapy.
• Each alternative has its own pros and cons, such as variable effectiveness and different levels of invasiveness.

Patient Experience

• During the procedure: Generally under anesthesia, so the patient should not feel any pain or discomfort.
• After the procedure: Some pain and discomfort can be expected, managed through pain medications. Detailed post-operative care instructions will be provided to aid recovery.

Patients should discuss all available options with their healthcare provider to choose the best course of action.