Complex treatment of trochanteric pressure ulcers

Abstract

Aim: We represent a clinical case, which reveals complex treatment of pressure ulcers, using surgical, conservative and rehabilitative treatment and not achieving positive effect. A 28 year old paraplegic male complained of non-healing, discharging wounds on both hip regions. Pressure sore in the region of right hip - 10x7 cm, on the left hip - 10x6cm, both wounds have tunnels, spread bad odor and secrete serous fluid. 9 months ago excision and myocutaneous flap were performed on a left decubitus ulcer. Due to failed healing of the wounds, the patient was hospitalized to LUHS Kaunas Clinics, Plastic and Reconstructive Surgery department. Method: After the patient was hospitalized, silver impregnated and hydrocolloid dressings were applied, also topical antimicrobial creams containing silver were used. Pressure sores were washed with antiseptic solutions. Systematic antimicrobial therapy was given according to culture results from wound-swab - moderately Pseudomonas aeruginosa. Necrectomies were performed on both wounds, negative pressure therapy was also used. In the course of complex treatment, pressure sores granulated, secretion diminished. The patient was consulted by a dietologist, special nutritional mixture was prescribed to enhance patients nutritional needs. Also the patient received kinesiotherapy and physiotherapy. Despite complex treatment, patient developed fever, blood test showed signs of inflammation. Pelvic organ CT indicated purulent coxitis. The patient was transferred to mixed traumas department, surgery was performed. Blood culture showed sepsis, corresponding systemic antibiotics were given. Results / Discussion: After a complex treatment, wounds didn’t heal completely, a frequent complication – osteomyelitis – occurred. Conclusion: Even in the case of complex treatment, positive results don't always occur.