When do people get bedsore over hip/side bone (trochanter)?

• This happens when the body is quite sick and unable to move due to paralysis, trauma, fractures, old age, etc.
• Patients admitted in the hospital for long time, especially in ICU or on ventilator.

All these ailments make the patient immobile and hence the prolonged excessive pressure over trochanter region make them prone for developing bed sore.

How is bedsore over hip/side bone (trochanter) treated at kayakriti?

A. For categories I and II bedsore

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

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

B. For categories III and IV bedsore

The patient definitely needs admission in a hospital and all the investigationsare 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 proper debridement is done to excise the bedsore in total, remove the infected portion of the trochanter 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 trochanter bed sore - if the wound is severely infected and might need further debridement or if the defect is too large to be closed in one stage 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 infectionand 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 a local flap, i.e. using the skin and soft tissue from the surrounding normal area, especially Tensor Fascia Lata muscle flap with overlying skin, rotation flap, V to Y advancement flap, etc. Dr Amit Agarwal has whole lot of flaps in his kitty for the coverage of trochanterpressure 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.