- 期刊
- OpenAccess
Bilateral hip disarticulation with total thigh flap for sacrum and ischium massive pressure ulcers in a spinal cord injury patient: A case report
摘要
Pressure ulcers often occur in patients with spinal cord injury (SCI), with a prevalence of up to 30%. Even after multiple surgical interventions, patients with SCI exhibit high recurrence rates and may develop massive ulcers complicated by chronic wound infection. Hip disarticulation is undertaken as a final treatment to ensure adequate soft tissue coverage and infection control. In this paper, we describe the management of a 41-year-old man with T12-L1 complete paraplegia who exhibited recurrent bilateral pressure ulcers over the ischial and sacral regions with septic shock. Empirical antibiotics were provided for methicillin-resistant Staphylococcus aureus coverage, followed by a colostomy to prevent fecal contamination. We subsequently performed bilateral hip disarticulation and total thigh flap application at an interval of 1 week. Postoperatively, the patient experienced wound dehiscence, which healed after another operative wound closure. We addressed the patient's malnutrition (albumin: 1.5 gm/dL) by providing adequate food and oral glutamine and the anemia (hemoglobin: 7.0 g/dL) with several cycles of component therapy. Physical therapy with upper extremity training for trunk balance was initiated at 1 month post operation. Psychiatrists and social workers were devoted to helping the patient maintain a positive attitude. A small defect in the wound area was managed with wet dressings until discharge. At the 1-year follow-up, the skin and flap were viable and intact, without recurrence of the pressure ulcer. The patient could ambulate smoothly using a wheelchair, without body imbalance. In conclusion, bilateral hip disarticulation with total thigh flap application is a rescue procedure that can be the last resort for sepsis due to massive pressure ulcers in malnourished SCI patients.
延伸閱讀
- Wei, M. H. (2004). The Use of Sliding Hip Compression Screw in the Treatment of Displaced Femoral Basal Neck Fracture in an Elderly Patient with Interlocking Nail over Ipsilateral Femoral Intramedullary Canal-Case Report. 東港安泰醫護雜誌, 10(3), 153-158. https://doi.org/10.7078/TSMHMNJ.200409.0153
- Chen, S. J., Hu, C. H., & Chang, Y. C. (2003). Iliac Vessel Injury by a Cement Spacer for Two-Stage Revision of Infected Hip Arthroplasty: A Case Report. Journal of Orthopaedic Surgery Taiwan, 20(1), 48-51. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200303-20-1-48-51-a
- Li, Y. D., Tang, H. C., Ueng, C. J., Kao, F. C., Cheng, C. Y., & Chan, Y. S. (2018). Hip arthroscopy for the intra-articular sequelae after Thompson-Epstein type I-II traumatic hip dislocation: A 2-year minimal follow-up. Formosan Journal of Musculoskeletal Disorders, 9(1), 7-12. https://doi.org/10.6492/FJMD.201802_9(1).0002
- Yen-Shuo Lai、Yao-Chou Lee（2023）。Inverted U-Shaped Anterolateral Thigh Flap and Prevertebral Fascia for Circumferential Pharyngoesophageal Reconstruction - A Case Report。臺灣整形外科醫學會雜誌，32(2)，216-223。https://www.airitilibrary.com/Article/Detail?DocID=a0000593-N202306220011-00011
- Tu, K. C., Tong, K. M., Wang, S. P., & Lee, C. H. (2019). Periprosthetic joint infection of hip with medial migration of acetabular component complicated with rupture of external iliac artery-A case report and review of literatures. Formosan Journal of Musculoskeletal Disorders, 10(4), 179-183. https://doi.org/10.6492/FJMD.201911_10(4).0007