Dermatosurgery -Tricks of the Trade
Case presentationA 64-year-old male patient presented with a grade IV sacral decubitus that had been present for twelve years. The ischemic tissue lesion developed 14 years ago as a result of tetraplegia after a cervical vertebra fracture. An 8 × 3 cm diameter and 2 cm deep soft tissue defect extending to the os sacrum was observed on the buttocks (Figure 1). Until then, conservative wound therapy with wound dressings (foam, hydrofiber, and alginate dressings) and vacuum dressings had been performed, but had not resulted in restitutio ad integrum of the wound. Magnetic resonance imaging of the pelvis revealed neither fistula tracts nor osteitis. Tissue samples were taken from the ulcer and the os sacrum to rule out malignancy in the fine tissue and microbially-induced osteomyelitis, and to evaluate the need for perioperative antimicrobial therapy.
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