When do people get bedsore over lower back region (sacrum)?

• This happens when the body is quite sick and unable to move due to some primary ailments, like paralysis, trauma, fractures, old age, etc.
• Patients admitted in the hospital for long time, especially in ICU or on ventilator, are also prone for developing bed sores.

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

How is bedsore sore over lower back region (sacral) 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 and the patient may be sent home with oral antibiotics and regular specific dressings are advised.
• Follow up is done every week initially and later once 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 investigations are done with respect to see his nutritional status and surgical fitness. After admission, Pre-Anaesthetic Check-up is done. Neurological, cardiac, physician clearances been done for surgical fitness. Once the patient is vitally stable and clear, surgical treatment 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 sacral bone and then the resultant defect is closed with a flap cover from the surrounding area in the same sitting.
• Sometimes two staged surgery is done for sacral bedsore - 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 infection, and the condition of the patient has improved over time, then a 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 gluteus maximus muscle flap with overlying skin, rotation flap, V to Y advancement flap, etc. Dr Amit Agarwal has a whole lot of flaps in his kitty for the coverage of sacral pressure sore.

• In Rare cases, the defect is too large, and it would not be possible to cover it with local surrounding skin. In such cases, microvascular free flap is harvested from another part of the body and transferred to sacral area and the vessels of the flap are joined with the vessels of the region using using microsurgical techniques.

Suction drain is also placed under the flap, for drainage of any collection of fluid underneath between the wound and flap.