Residual Sterile Muscle Fibrosis Following Partial Debridement of a Pressure Ulcer

Pressure ulcers are severe medical conditions, often stemming from inadequate pressure redistribution. Proper wound management is vital to ensuring optimal healing outcomes. Surgical intervention is often indicated and consists of the removal of devitalized tissue down to viable tissue in order to facilitate optimal wound healing, either via surgical reconstruction or per secundam. A 52-year-old man with paraplegia and recurrent respiratory infections developed a pressure ulcer on his right upper leg. Under conservative measures, the ulcer persisted, accompanied by a prolonged fever. Surgical debridement was performed down to the muscle fascia, intentionally preserving the covered avital muscle for subsequent sterile fibrosis. Pressure ulcers present substantial clinical challenges, particularly in patients with extensive comorbidities. In such cases, traditional surgical management may not always be the most feasible or optimal approach. Partial debridement, with a focus on preserving the muscle fascia, provides an effective means for removing infected tissue while allowing the remaining tissue bulk to undergo sterile necrosis and fibrosis. This approach serves as an interim strategy in complex pressure ulcer cases, avoiding significant muscle loss and thus circumventing the necessity for reconstructive flap surgery for sizable wound defects. Complex pressure ulcers in high-comorbidity patients present significant challenges in wound management. The concept of partial debridement with remaining sterile muscle fibrosis can serve as an interim solution, facilitating conservative wound healing.