Sacral Pressure Sore
Elof Eriksson, MD
, Julian Pribaz, MD
History:
63 year old woman who is bedridden since 9 months after a stroke. 7 months ago she developed a sacral pressure sore that has been treated with local wound care and offloading. Gradually, the ulcer has grown larger in spite of optimal wound care. She is therefore referred to plastic surgery for surgical closure.
Findings:
63 year old woman with left sided hemiplegia. She cannot sit or stand. Over the sacrum she has a 9 X 7 cm pressure sore extending to the bone which is partially devoid of periosteum. the wound edges are undermined approximately 2 cm in all directions. There is no evidence of invasive infection.
Fig. 1. Deep, undermined sacral pressure sore.
Diagnosis:
Sacral pressure sore in hemiplegic bedridden patient.
Differential Diagnoses:
None.
Workup Required:
Xray of Sacrum and Coccyx to determine amount of bone destruction. Physical examination, routine laboratory tests including protein profile and hemoglobin A1C.
Plan:
Hospital admission with a surgical procedure under general anesthesia for debridement and flap closure. Referral to rehab after approximately one week.
Expertise Needed:
Plastic surgeon who is used to treating pressure sores.
Treatment:
Under general anesthesia, the inside of the pressure sore was stained with methylene blue and then excised completely in a pseudotumor fashion. The superficial 1cm of the sacrum was removed with an osteotome. Bilateral V to Y flaps were then outlined, dissected and advanced to close the wound. Two large suction drains were placed.
Fig. 2. Pressure sore after debridement and outline of bilateral V to Y advancement flaps.
Fig. 3. Flaps have been dissected and are ready to be advanced to close the wound.
Fig. 4. The flaps have been sutured in place.
Follow Up:
References
Factors Affecting Wound Healing in Individuals With Pressure Ulcers: A Retrospective Study
Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy
Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross-over trial
https://pubmed.ncbi.nlm.nih.gov/29481325
https://pubmed.ncbi.nlm.nih.gov/29986022
https://pubmed.ncbi.nlm.nih.gov/29277963