Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chronic, non-healing ischial pressure ulcer, currently classified as Grade 4. The wound has been present for [Duration], with progressive deterioration despite conservative management. Patient reports [Pain/No pain] at the site, with associated [Exudate/Odor/Fever]. History significant for limited mobility, underlying bony prominence, and previous failed conservative wound care interventions.
Clinical Examination Findings
Physical examination reveals a deep, full-thickness ulcer over the ischial tuberosity. The wound bed exhibits exposed bone, tendon, and muscle, with visible signs of osteomyelitis. Periwound skin shows signs of maceration and induration. Measurements: [Length] x [Width] x [Depth] cm. Tunneling/undermining noted at [Clock positions]. Presence of [Purulent/Serosanguinous] discharge; no active bleeding.
Treatment Protocol
Surgical intervention planned: Radical debridement of necrotic tissue and infected bone, followed by reconstructive flap surgery (e.g., gluteal rotational flap or V-Y advancement flap). Post-operative management includes strict offloading, pressure redistribution mattress, nutritional optimization (high protein/vitamin C), and systemic antibiotic therapy tailored to wound culture results.