Posts Tagged decubitus ulcer
When I tell people I have a hybrid plastic surgery practice, I am not talking about a fuel efficient car. I am talking about the fact that I do both cosmetic surgery and medically-necessary surgery. Part of the medically-necessary surgery includes the repair of pressure wounds (also called decubitus ulcers.)
Not only is this type of surgery not cosmetic, it can be pretty ugly. It is surgery to assist often long standing wounds in healing in often significantly ill patients. If possible such a wound is repaired using tissue from adjoining areas of the body called fasciocutaneous and musculocutaneous flaps after scar and debris is cut away. This isn’t pretty, but the patient was pretty happy to not have an open wound afterward.
I do these at an LTAC in Santa Ana at which good wound care nursing services are available before and after surgery. Not all patients are candidates for surgical correction. Often these patients have had these wounds for months or years at the time they are referred for possible surgery.
Below are images showing an example case I did years ago (after “Page 2″ so those who don’t like pictures of wounds can pass.)
Originally posted 2011-07-13 07:30:57.
“My mother has been paralyzed for many years and needed many surgeries. She has had a problem after a recent pressure ulcer surgery. The wounds have opened. Can you help her out? Her recent pressure wounds had been there for over a year and weren’t healing.”
Occasionally this blog connects me with potential patients who live locally in Orange County. I rarely meet this kind of person via the blog however and am not always able to help patients after recent surgery by another surgeon. With pressure ulcer surgery on large open wounds there are periods of opportunity during which surgery has the best potential. Right after an operation complicated by wound disruption, the wounds are frequently fragile and need to heal for a while before surgery can be performed successfully.
Pressure ulcer surgery is difficult in that it requires a protracted period of care after the operation itself. Medicare restricts how long a patient can be kept in an acute care hospital, so I do these cases in a long term acute environment (LTAC.) I specifically do the cases in an LTAC that I frequent. Other surgeons deal with these cases differently. Not many plastic surgeons spend much time doing decubitus ulcer surgery. These cases take time and are not infrequently complicated even when everything is optimal.
Pressure ulcer surgery is also best accomplished with a motivated patient who is ready and able to restrict pressure to the newly operated wound. Patients who sit on their newly-operated wounds shortly after surgery have poor success rates.
John Di Saia MD
Originally posted 2011-11-09 07:30:11.