Name of the Procedure:

Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy

Summary

This procedure involves surgically removing a sacral pressure ulcer (a sore that develops on the lower back between the hipbones) to prepare the area for closure using a muscle or skin flap, or a skin graft. This specific procedure also includes the removal of part of the bone (ostectomy) to ensure a clean and stable foundation for the graft or flap.

Purpose

The purpose of this procedure is to treat severe pressure ulcers that have not healed with conventional methods. The goals are to remove infected or dead tissue, reduce the risk of infection, provide a healthy base for grafting, and ultimately promote healing of the ulcer.

Indications

• Chronic, non-healing sacral pressure ulcer
• Presence of dead (necrotic) tissue or bone infection (osteomyelitis)
• Deep ulcers involving the bone (sacrum)
• Patients who have not responded to less invasive treatments

Preparation

• Patients may be required to fast (nothing by mouth) for at least 8 hours before the procedure.
• Blood tests, imaging studies, and possibly cultures from the ulcer will be conducted to assess infection and plan the procedure.
• Certain medications, such as blood thinners, may need to be adjusted or discontinued with the advice of the healthcare provider.

Procedure Description

1. The patient is administered general anesthesia for full sedation.
2. The surgical area is sterilized and draped.
3. The surgeon excises (cuts out) the ulcer along with any surrounding dead or infected tissue.
4. An ostectomy is performed where a portion of the sacral bone may be carefully removed.
5. The prepared surgical site is then ready for closure using a muscle or skin flap, or a skin graft, depending on the specific needs of the patient.
6. The wound is closed, and dressings are applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the ulcer and the need for ostectomy.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon (specialized in plastic or reconstructive surgery)
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Possibly a wound care specialist

Risks and Complications

• Infection
• Bleeding
• Reaction to anesthesia
• Delayed wound healing
• Failure of the graft or flap
• Recurrence of the pressure ulcer
• Damage to surrounding tissues, muscles, or nerves

Benefits

• Removal of infected or necrotic tissue, reducing the risk of further infection.
• Provides a healthy base for healing.
• Promotes faster and more effective healing of the ulcer.
• Potential improvement in mobility and quality of life.

Recovery

• Post-procedure, patients will be monitored for a few hours to a few days in a hospital setting.
• Pain will be managed with prescribed medications.
• Specific instructions will be provided on wound care, dressing changes, and activity restrictions.
• Physical therapy may be recommended to aid in recovery.
• Follow-up appointments will be necessary to monitor healing and address any complications.

Alternatives

• Less invasive treatments such as topical dressings, negative pressure wound therapy, and debridement.
• Medication management for infection or pain.
• Hyperbaric oxygen therapy.
• Pros and cons: Less invasive treatments may be slower to produce results and might not be effective for deep or infected ulcers, while surgery offers a potentially definitive solution but comes with higher risks.

Patient Experience

Patients may experience pain and discomfort post-procedure, which can be managed with pain medications. During recovery, adhering to wound care protocols and physical activity guidelines is crucial for successful healing. Emotional support and confidence in the care plan can enhance overall comfort and cooperation.