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Landmarks for Sacral Debridement in Sacral Pressure Sores
Joshua H Choo1, Bradon J Wilhelmi
1From the Division of Plastic Surgery, University of Louisville, Louisville, KY.
Annals of Plastic Surgery
|July 25, 2015
Summary
The posterior superior iliac spine (PSIS) reliably indicates the dural sac termination at S2/S3. Surgeons should exercise caution during sacral debridement above the PSIS to avoid dural space injury.
Area of Science:
- Anatomy
- Surgical Procedures
- Osteomyelitis
Background:
- Sacral osteomyelitis from pressure ulcers often needs debridement.
- Advanced cases pose challenges due to unclear safe resection margins.
- Concerns exist regarding dural space entry and flap compromise.
Purpose of the Study:
- To define the relationship between posterior pelvic landmarks and the dural sac termination.
- To provide anatomical guidance for safe sacral debridement in complex cases.
Main Methods:
- Cadaveric dissection of the sacrum (n=6).
- Detailed analysis of the dural sac's relationship to posterior pelvic bony landmarks.
Main Results:
- The dural sac terminated at the S2/S3 junction, averaging 0.38 cm distal to the posterior superior iliac spine (PSIS).
- Sacrum thickness at this level was 1.7 cm midline and 0.5 cm at foramina.
Conclusions:
- The PSIS is a dependable landmark for the S2/S3 junction and dural sac termination.
- Conservative debridement is advised medial to sacral foramina above the PSIS.
- Alertness to potential dural involvement is crucial for aggressive debridement above this level.