Definition & Overview

A trochanteric pressure ulcer is a wound that develops on the area covering the greater trochanter, which is the upper part of the thighbone. The trochanter can usually be felt by pressing down on the hips.

There are two types of trochanter: greater (upper) and lesser (lower) trochanters, which are located in the area where the thigh and muscles join. The greater trochanter, also called the outer trochanter, is more prominent and only a small amount of tissue separates it from the skin.

It is one of the areas that are vulnerable to a pressure ulcer because it is where pressure develops when a person is lying down. If a person remains in the same position for an extended period, there’s a good chance for a trochanteric pressure ulcer to develop. This usually affects paraplegics or those who are unable to change their position while lying down.

Similar to other types of pressure ulcers (ischial and sacral), trochanteric pressure ulcers develop in stages. Such stages describe the severity of the condition.

Stage 1 – The pressure ulcer does not display a break in the skin. However, the area experiences a change in colour. It could also feel warm and itchy. In some cases, a small amount of pain is present.

Stage 2 – The pressure ulcer displays an open wound that affects the dermis and epidermis layers. The wound is shallow, and the only damaged tissue is the skin.

Stage 3 – The pressure ulcer damages the skin and any fat underneath but not the underlying muscle or bone. The wound looks like a deep crater, but dead tissue is not present at this point.

Stage 4 - This stage is the most severe due to the presence of dead tissue. At this stage, the wound already affects the muscle and quite possibly the bone as well. This is considered serious as the presence of dead tissue indicates the possibility of a life-threatening infection.

Trochanteric pressure ulcers are difficult to treat. Most wounds heal on their own once they have been cleaned properly, but in the case of this type of pressure ulcer, the wound doesn’t heal as fast as it should due to spasms in the area.

The type of treatment required to treat the condition will depend on the stage of the pressure ulcer. In stage 1 pressure ulcers, treatment may not be required at all. Most of the time, the condition dissipates when the pressure is relieved from the area.

Stage 2 pressure ulcers may require debridement because of the open wound. Since only the epidermis and dermis layers of the skin are affected, surgery is not required at this point.

Stage 3 pressure ulcers will require surgery because of the depth of the wound. In most cases, the wound can be closed with primary suture.

Stage 4 pressure ulcers require surgery to remove the dead tissue and affected pieces of bone. At this stage, the wound will require myocutaneous flap surgery or a skin graft to close.

Who Should Undergo & Expected Results

The excision of trochanteric pressure ulcer with primary suture is recommended for patients suffering from stage 3 of the condition. At this point, removing the ulcer will not result in a wound that is too deep that it would require tissue transplant. After excising the trochanteric pressure ulcer and cleaning the wound thoroughly, the wound can be closed by simply suturing the two sides together.

During the recovery process, pressure must be relieved from the area as often as possible. Unfortunately, due to the nature of pressure ulcers, recurrence is still a possibility.

How Does the Procedure Work?

Prior to any surgical procedure, the trochanteric pressure ulcer is carefully assessed as well as the patient’s overall health. Pressure ulcers develop due to a combination of different factors, such as the patient’s nutrition and shear or friction in the area. All of these must be considered for the treatment to be effective.

If surgery is deemed necessary, the patient is given anaesthetics for the procedure, which is performed in a hospital’s operating room. The surgeon will proceed by surgically excising the pressure ulcer before cleaning the wound. The wound will then be closed using a primary suture and dressed. In some cases, creams and ointments may be applied to prevent tissue damage.

If an infection was discovered during surgery, or if one develops during the healing process, antibiotics may be prescribed. Antibiotics will only be used to treat an infection and not the pressure ulcer itself.

Possible Risks and Complications

Without prompt treatment, there is a good chance that a trochanteric pressure ulcer will progress into severe stages. When this happens, an infection could set in that may threaten the patient’s life.

Unfortunately, even with treatment, infection is still a possibility. As such, close monitoring is highly recommended so an infection can be discovered and promptly treated with antibiotics before it gets any worse.

There is also a possibility of recurrence. One of the primary reasons why pressure ulcers develop is because the patient is unable to relieve pressure on a certain area. If the patient is in the same condition that led to the initial occurrence of a pressure ulcer, then there is a good chance that another one will develop even after the surgical treatment.

References:

  • M. Marchi, S. Battaglia, S. Marchese, E. Intagliata, C. Spataro, R. Vecchio; “Surgical reconstructive procedures for treatment of ischial, sacral and trochanteric pressure ulcers”; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511039/
  • “Chapter 17 Pressure Sores; Practical Plastic Surgery for Non-surgeons”; http://practicalplasticsurgery.org/docs/Practical_17.pdf
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