When do people get bedsore over seat bone region (ischium)?

• People with paraplegia due to spine injuries where lower half of body is not working or mobile, they are in a habit of being seated on awheelchair for a long time.
• When the body is quite sick and unable to move due to some primary ailments, like paralysis, trauma, fractures, old age, etc.

All these ailments make the patient confined on bed or wheelchair in upright or sitting position for long time and hence the prolonged excessive pressure over seat bonemake them prone for developing bed sore.

How is bedsore sore over seat bone region (ischium) treated at Kayakriti?

A. For categories I and II

The patient might not need admission if other comorbidities and factors are under control.

• Attendants are advised all the managementand the patient may be sent home with oral antibiotics and regular specific dressings are advised.
• Follow up is done every week initially and later once or twice in a monthfor three months after healing is complete.

B. For categories III and IV

The patient definitely needs admissionin a hospital and all the investigations are done with respect to see his nutritional status and surgical fitness. After admission, Pre-Anaesthetic Checkup is done. Neurological, cardiac, physician clearances been done for surgical fitness. Once the patient is vitally stable and clear, surgical correction is planned.

• Usually, we can proceed with a single stage surgery in which after proper debridement- we excise the bedsore in total, remove the infected ischial bone, and then the defect is closed with a flap cover from the surrounding area in the same sitting.
• Sometimes two staged surgery is done for bedsore - if the wound is severely infected and might need further debridement or if the patient is quite sick to undergo coverage with flap in the same sitting.

After the first stage debridement of the sore, we apply Negative Pressure Wound Therapy (VAC) for 5-7 days. After a week, VAC is removed and if the wound is better with no signs of active infection and the condition of the patient has improved over time then definite cover with flap is planned and patient is prepared for next second stage surgery.

Closure of the wound is done in maximum cases by local flaps, i.e. using the skin and soft tissue from the surrounding normal area, especially banner flap, posterior thigh flap, gluteus maximus muscle flap with overlying skin and rotation flap. Dr Amit Agarwal has whole lot of flaps in his kitty for the coverage of ischial pressure sore.

Suction drain is also placed under the flap, for drainage of any collection of fluid underneath and avoid the cavity between the wound and flap.