Name of the Procedure:

Excision, Trochanteric Pressure Ulcer, With Skin Flap Closure; with Ostectomy

Summary

This procedure involves removing a pressure ulcer located near the hip bone (trochanteric area) and closing the wound with a skin flap. Additionally, a part of the underlying bone (ostectomy) will be removed to promote healing and prevent infection.

Purpose

To treat deep, chronic pressure ulcers that have developed over the trochanteric area, alleviating pain and preventing complications such as infection and further tissue damage. The expected outcome is a healed ulcer with reduced risk of recurrence.

Indications

• Chronic, non-healing pressure ulcers over the hip (trochanteric area).
• Severe tissue damage extending to the bone.
• Persistent infection or severe pain that does not respond to more conservative treatments.
• Eligible patients may include those with limited mobility or underlying conditions that predispose to pressure ulcers.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustments to current medications might be necessary, particularly blood thinners.
• Pre-operative assessments including blood tests, imaging studies, and possibly a consultation with an anesthesiologist.

Procedure Description

1. The patient will be positioned appropriately, usually lying on their side or belly.
2. General anesthesia will be administered to ensure the patient is asleep and pain-free.
3. The surgeon will make an incision around the pressure ulcer to fully excise (remove) the damaged tissue.
4. A section of the underlying bone may be removed (ostectomy) to reduce pressure and facilitate healing.
5. A skin flap, often taken from nearby healthy tissue, will be rotated and sutured to cover the wound.
6. The surgical site is usually dressed, and a drain may be placed to remove excess fluids.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity and extent of the ulcer and bone involvement.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• A team led by an orthopedic or plastic surgeon.
• Surgical nurses and technicians.
• An anesthesiologist to administer anesthesia and monitor the patient.

Risks and Complications

• Common risks include infection, bleeding, and pain at the surgical site.
• Rare complications may include blood clots, adverse reactions to anesthesia, or failure of the skin flap to integrate properly.
• Management may involve antibiotics for infection, pain management, and possibly additional surgery for complications.

Benefits

• Healing of the ulcer and reduced risk of recurrence.
• Alleviation of pain and prevention of severe complications like osteomyelitis (bone infection).
• Improved quality of life and mobility.

Recovery

• The patient will be monitored in the hospital for a few days to ensure proper healing and manage any complications.
• Specific care for the surgical site will be required, including dressing changes and possibly the use of a drain.
• Physical therapy may be recommended to help improve mobility without putting pressure on the surgical site.
• Full recovery may take several weeks to months, with follow-up appointments to monitor healing.

Alternatives

• Non-surgical treatments such as specialized wound care, pressure relief devices, or negative pressure wound therapy.
• Less invasive procedures might not be as effective for severe ulcers that involve deeper tissue and bone.
• Amputation in extreme cases where conservative and surgical treatments fail.

Patient Experience

• The patient will be under general anesthesia and won't feel anything during the surgery.
• Post-surgery, pain and discomfort are common but manageable with medications.
• Gradual improvement in symptoms as the wound heals, with supportive care to ensure comfort and promote healing.