Monday, January 27, 2020

Trochanteric Pressure Sore Management In Paraplegia with Flap Cover

Approach to Long-Standing Pressure Sore

Patient when approaching u on the first visit, he will be emaciated, long-standing ulcer non-healing ulcer over the pressure areas, sometimes over multiple areas since the patient will be on prolonged lying down position. 

Approach 1 :

Routine Blood Investigation and look for Sr.protein which will help in wound healing. Ask the attenders to keep the patient motivated and to have adequate oral intake.

Approach  2:

Once Clinically improved ask them to mobilize the patient well, clean bath daily, dressing of the wound regularly. One time debridement thoroughly has to be done. Without wasting time put on vac dressing so that the wound shrinks well.

Approach 3 :

Then examine for the wound and check for x-ray and status of any organism growth in the wound.
Plan for flap cover, it might be a skin flap or a muscle flap. Usually preferred is a skin flap since most of the time muscle will be flabby and to prevent huge seroma or blood loss post-operative always skin flap is preferred.

70 yr old male paraplegic come with a pressure ulcer, the wound looks healthy after the approaches are done listed above. Now on table debridement and rotation / Limberg flap is planned for the wound site cover.

Trochanteric Pressure Ulcer

The flap is raised on the plane above the muscle fascia, preoperative a perforator can be located nearby and include the flap. this makes the flap more versatile, to avoid tension at the flap important is to keep the hip flexed all time while doing the flap.

On table Debridement & Flap Raised
Flap inset is given with layered closure and the main trick is to mobilize flap around and not the flap alone. measurements of the flap to referred from textbooks. Not the forget is the drain tuber to be secured adequately and kept until the dead space is void inside.

Immediate Post Operative Status
Plan for delayed suture removal as your needs. Mobilize him adequately will on suture before the final suture removal is done. always be prepared for secondary healing and secondary suturing . Give adequate pressure voiding dressing and bed for the right person and prevent further wound elsewhere. keep him under routine voluntary checkup
Postoperative follow up - 15 days

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