Decubitus ulcers in surgery

decubitus ulcersDecubitus ulcers can be disastrous complications of immobilization. They result from prolonged pressure that robs tissue of its blood supply, irritative or contaminated injections, prolonged contact with moisture, urine, and feces. Most patients who develop decubitus ulcers are also poorly nourished. Pressure ulcers are common in paraplegics, immobile elderly patients after orthopedic procedures, and drug addicts who take overdoses and lie immobile for hours. The ulcers vary in depth and often extend from skin to a bony pressure point such as the greater trochanter, the sacrum, or the head.

Most decubitus ulcers are preventable. Hospital-acquired ulcers are nearly always the result of inadequate nursing care, inappropriate positioning on operating tables, and ill-fitting casts or other orthopedic appliances.

Treatment of decubitus ulcers

Treatment is difficult and usually prolonged. The first important step is to incise and drain any infected spaces or necrotic tissue. Dead tissue is debrided until the exposed surfaces are viable. Many ulcers will then heal spontaneously. However, deep ulcers may require surgical closure, sometimes with removal of underlying bone. The defect may require closure by judicious movement of thick, well-vascularized tissue into the affected area. Musculocutaneous flaps are the treatment of choice when chronic infection and significant tissue loss are combined. However, recurrence is common because the flaps are usually insensate.

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