Successful management of extensive stage four sacral pressure ulcer in a paraplegic patient: A case report

Pressure ulcers (known as pressure injuries) occur when a bony prominence, such as the sacrum, is subjected to prolonged pressure and can result in soft tissue injury. Continuous and attentive repositioning is necessary to prevent and cure pressure-induced wounds.

A 49-year-old patient who presented to the hospital with a case of paraplegia post spinal injury due to Road Traffic Accident, with a huge infected sacral bed sore and complaints of generalized weakness and fever. His ulcer was 15 cm ∗ 15 cm ∗ 8 cm, grade 4. He underwent flap reconstruction, was post-operatively transferred into the ward, and started on IV antibiotics and analgesia. The flap is well vascularized with no signs of infection or dehiscence.

Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue. However, operational care in more severe cases or to encourage patient satisfaction may be necessary.

The bilobed flap is the best technique for healing sacral pressure ulcers. It has a plentiful supply of blood. The layout is uncomplicated and straightforward. The fact that it has a low risk of complications is crucial. It ought to be taken into account as a component of the local flap arsenal for sacral pressure ulcers.