Name of the Procedure:

Unlisted Procedure, Excision Pressure Ulcer

Summary

Excision of a pressure ulcer is a surgical procedure to remove damaged tissue caused by prolonged pressure on the skin and underlying tissues. This helps promote healing and prevents further complications.

Purpose

The primary purpose of this procedure is to treat pressure ulcers, which are often caused by extended periods of immobility, commonly seen in bedridden or wheelchair-bound patients. The goals include removing necrotic tissue, reducing infection risk, and facilitating the healing process.

Indications

• Presence of stage III or IV pressure ulcers
• Non-healing ulcers despite conservative treatment
• Evidence of infection or dead tissue within the ulcer
• Patients who have immobility due to chronic conditions or paralysis

Preparation

• Pre-procedure fasting as instructed by the healthcare provider
• Adjustments to medications, especially blood thinners, as guided by the healthcare team
• Diagnostic tests, such as blood work and imaging studies, to assess overall health and the extent of the ulcer

Procedure Description

1. The patient is positioned to provide optimal access to the ulcer site.
2. Anesthesia or sedation is administered to ensure the patient's comfort.
3. The surgical area is sterilized.
4. The surgeon excises the damaged and necrotic tissue from the pressure ulcer using surgical instruments.
5. Healthy tissue margins are obtained, and care is taken to avoid damage to surrounding structures.
6. The wound may be left open, closed primarily, or covered with a skin graft, depending on the situation.
7. Dressings are applied to protect the wound.

Duration

The procedure typically takes between 1 to 2 hours, depending on the size and depth of the ulcer.

Setting

This procedure is commonly performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon specializing in wound care or plastic surgery
• Nurses and surgical technologists
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Delayed wound healing
• Adverse reactions to anesthesia
• Scarring or deformity of the excised area

Benefits

• Enhanced wound healing
• Reduced risk of infection
• Improved quality of life and mobility in some cases
• Prevention of further tissue deterioration

Recovery

• Post-procedure care includes wound inspection and dressing changes.
• Patients are advised to avoid pressure on the affected area.
• Follow-ups with the healthcare provider to monitor healing and manage any complications.
• Recovery can take several weeks to months depending on the extent of the ulcer and the patient’s overall health.

Alternatives

• Conservative wound care with frequent dressing changes and topical treatments
• Negative pressure wound therapy (NPWT)
• Hyperbaric oxygen therapy
• Pros: Non-invasive and may be suitable for less severe ulcers.
• Cons: May require longer healing time and frequent interventions to ensure ulcer management.

Patient Experience

Patients might feel soreness or mild discomfort post-surgery, which can be managed with pain medications prescribed by the doctor. Immobilization or specific positioning may be required to minimize pressure on the healing site, enhancing comfort and promoting recovery.