Bed Sore over Hip/Side Bone (Trochanter)

Bedsore Development

Bedsores, also known as pressure ulcers, can develop due to prolonged periods of lying in a lateral or side position on a bed. These bedsores can appear on one side or both sides of the hip or trochanter region. Typically, one side of the sore is deep, and the other side is superficial. The location of the bedsore depends on the patient’s position:

• Prolonged seated position can lead to Ischium(seat bone) bedsores .
• Prolonged lying-down position can cause sacrum (lower back) bedsores.
• Prolonged side position can result in trochanter (side bone) bedsores.

Other common areas for bedsores include the heel, elbow, malleolus (ankle), knee, scapula (shoulder blade) , and occiput (back of the head).

Development of Trochanter Bed Sores

Trochanter bed sores often occur when a person’s body is severely affected and unable to move due to factors such as paralysis, trauma, fractures, old age, or prolonged hospitalization, especially in the ICU or on a ventilator. These conditions lead to immobility, causing prolonged excessive pressure on the trochanter region and making patients susceptible to developing bed sores.

Categories of Bed Sores

Bedsores are categorized based on the extent of damage:

• Category I: Generalized redness over the pressure areas.
• Category II: Partial loss of skin, similar to an injury from forceful rubbing.
• Category III and IV: Full-thickness loss of skin and muscle in category III, with exposed bones in category IV.

Regardless of the stage, relatives or attendants should consult a plastic surgeon immediately to prevent further progression.

Treatment at Kayakriti

For Categories I and II Bed Sores:

Patients with Category I or II bed sores may not require admission if other comorbidities and factors are well controlled. They are educated about wound management and are given specific dressings and oral antibiotics. Follow-up is typically scheduled every week initially and later once or twice a month for three months after complete healing.

For Categories III and IV Bed Sores:

Patients with Category III or IV bed sores require hospital admission. A comprehensive evaluation of their nutritional status and surgical fitness is conducted. After admission, a pre-anesthetic checkup is performed. Clearances from specialists such as neurologists, cardiologists, and physicians are obtained to ensure surgical fitness. Once the patient is vitally stable and medically cleared, surgical correction is planned.

• Single-Stage Surgery: In most cases, a single-stage surgery is performed, involving proper debridement. The procedure includes the total excision of the bed sore, removal of the infected portion of the trochanter bone, and closure of the defect with a flap in the same sitting.
• Local Flap Closure: The closure of the wound is typically achieved with local flaps, using the skin and soft tissue from the surrounding normal area. Common flaps used for closure include the Tensor Fascia Lata muscle flap with overlying skin, rotation flap, V to Y advancement flap, and more. Dr. Amit Agarwal offers a variety of flap options for the coverage of trochanter pressure sores.

A suction drain is also placed under the flap to drain any collection of fluid underneath and avoid the formation of a cavity between the wound and the flap.

In some cases, two-staged surgery is considered for trochanter bed sores, especially if the wound is severely infected and requires further debridement, if the defect is too large to be closed in one stage, or if the patient is too ill to undergo flap coverage in the same sitting.

Recovery After Surgery

• The patient is nursed in a prone, side lateral position.
• An air mattress is used,
• Proper Hygiene has to be maintained,
• Foley’s catheterization is done and
• Flap is being monitored regularly for any color changes, or any infection.
• The patient is kept on a soft diet for a few days, to decrease the frequency of stools.
• Dressing is done every alternate day.
• The patient is kept in the hospital for at least 10-14 days.
• Suction is removed once the amount is less than 10-15 ml in 24 hours.
• Sutures are removed after 2 weeks.
• Once the flap is settled and the patient is vitally stable, discharge is planned.

Patients receive instructions for home care, including the use of an air mattress, hygiene practices, and regular side-to-side turning. Follow-up visits are scheduled after one week and later once or twice a month as needed.