Name of the Procedure:

Excision, ischial pressure ulcer, with primary suture

Summary

This procedure involves surgically removing a pressure ulcer located over the ischial bone (the lower part of the pelvis) and then closing the wound with stitches to promote healing.

Purpose

The procedure addresses ischial pressure ulcers, commonly occurring in people with limited mobility. It aims to remove damaged tissue to prevent infection and promote healing.

Indications

• Chronic or non-healing ischial pressure ulcers.
• Signs of infection, such as redness, swelling, or pus.
• Necrotic (dead) tissue present in the ulcer.
• Unsuccessful response to non-surgical treatments.

Preparation

• Fasting for at least 8 hours prior to surgery.
• Adjustment or discontinuation of certain medications (e.g., blood thinners).
• Pre-operative blood tests and imaging studies to assess the ulcer.
• Pre-surgical clearance by a primary physician if necessary.

Procedure Description

1. Administration of anesthesia (general or regional) to ensure the patient is pain-free.
2. The surgeon cleans the ulcer and surrounding area with an antiseptic solution.
3. An incision is made around the ulcer to excise the damaged and infected tissue.
4. Any underlying bone involvement is addressed.
5. Once all non-viable tissue is removed, the wound edges are brought together and sutured closed.
6. A sterile dressing is applied to the site.

Tools and Equipment

• Surgical scalpel, forceps, scissors.
• Suture material.
• Antiseptic solutions and sterile dressings.

Anesthesia

• General anesthesia or regional anesthesia (spinal or epidural) depending on the patient's condition and preference.

Duration

The procedure typically takes 1-2 hours.

Setting

• Performed in a hospital or outpatient surgical center.

Personnel

• Surgeon.
• Operating room nurse.
• Anesthesiologist or nurse anesthetist.

Risks and Complications

• Infection.
• Bleeding.
• Poor wound healing or dehiscence (wound reopening).
• Scarring.
• Adverse reaction to anesthesia.
• Recurrence of the pressure ulcer.

Benefits

• Removal of infected or necrotic tissue.
• Reduced risk of systemic infection.
• Enhanced wound healing.
• Pain relief and improved comfort.

Recovery

• Patients may need to stay in the hospital for a few days.
• Wound care instructions including dressing changes and hygiene.
• Pain management with medications.
• Limited physical activity to avoid pressure on the ulcer site.
• Follow-up appointments for wound monitoring and stitch removal (if non-absorbable sutures were used).

Alternatives

• Non-surgical wound management (e.g., specialized dressings, offloading the pressure).
• Negative pressure wound therapy.
• Skin grafts or flap surgery if primary suture isn't feasible.

Pros and Cons of Alternatives:

• Non-surgical options may offer less immediate relief and slower healing.
• Skin grafts or flap surgery are more complex procedures with longer recovery times.

Patient Experience

• During the procedure: The patient will be under anesthesia and not feel any pain.
• After the procedure: Mild to moderate pain managed with medications. Some discomfort and swelling at the surgery site. Instructions on how to care for the wound and manage pain will be provided.