A complicated trochanteric pressure sore: what is the best surgical management? Case report

Abstract

Pressure sores are a common complication after spinal cord injury. But great advances in their management (nursing care, prevention and surgery) have been made in the last four decades. Neglected pressure ulcers may affect the adjacent joint, leading to septic arthritis.We report a paraplegic patient with a large trochanteric sore with hip arthritis, in whom we performed an upper femoral resection and acetabular curettage (Girdlestone's technique) and coverage with the homolateral vastus lateralis muscle flap in one stage. Some questions pertaining to this operation are discussed and there is a comparison with other ways of management described in the literature.We conclude that a successful outcome with the management of such large sores depends on a radical, aggressive operation to remove all of the affected tissue, and ensure a safe coverage with a reliable, viable muscle flap. The collaboration and the positive attitude of the patient towards the procedure and the result obtained are decisive in preventing recurrences.

Total thigh flaps as a salvage procedure in paraplegics with massive ulcers

“…The Girdlestone arthroplasty (proximal femoral neck resection) in association with soft tissue reconstruction is one alternative for large trochanteric and ischial ulcers that communicate with the hip joint (26)(27)(28)(29). In comparison to the total thigh flap, the…”

“…Girdlestone operation is much less traumatic in terms of surgical morbidity and of body image. Blood loss is less and both lower limbs are preserved; therefore, it is more acceptable to patients (29). This procedure was attempted initially in five of the 10 cases presented, but was found to be insufficient to allow for coverage of the massive defect.…”

Sepsis of the hip due to pressure sore in spinal cord injured patients: advocacy for a one-stage surgical procedure

“…This procedure is a much less traumatic therapy than disarticulation of a lower limb, 12 which should only be indicated in patients with severe and recurrent sores with no alternative treatments remaining. [13][14][15] There might nevertheless be discrepancies in the literature regarding the therapeutic management.…”