The patient has been a paraplegic for the past twenty years and has had multiple closures of ulcers around the back/buttock area with local skin and muscle flaps. Recently, I was contacted as the on-call plastic surgeon to address a recurrent open area of the left buttock/hip area. Due to patient’s clinical condition and elevated white blood cell count, a CT scan was obtained which showed multiple abscesses around the femur head. The femur and the hip joint form a ball and socket where the head of the femur fits in the hip joint groove, thus allowing movement of the thigh.
During surgical exploration, aggressive debridement of non-viable tissue and drainage of multiple abscesses was required. Most importantly, however, the femur head had been displaced from the hip joint, losing its blood supply. As a result, the entire femoral head was necrotic. Orthopedic surgery consultation was requested intra-operatively, and the patient was brought back for surgery several days later for a Girdlestone procedure.
After several weeks of dressing changes to make sure the area is clean and the patient is nutritionally optimized, closure of the open area was performed. This was a very difficult procedure, requiring two large muscle/skin flap and an third muscle flap to cover the femoral head defect. This procedure took approximately eight hours! I was unable to close the defect completely. However, the open area is significantly smaller than the original wound, and will close with closed vacuum dressing changes (VAC dressing).
The patient is several weeks out and the wound is stable and healing.
Being both a reconstructive and cosmetic surgeon assures I will never be bored! The next day, for example, I performed a breast augmentation which took about an hour to complete. Quite a change and what a variety!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call (714) 834-0101.
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