Ischial Pressure Sores


Ischial Pressure Sores

Neil S. Sachanandani & Thomas H. H. Tung
A 35 year paraplegic male with a right-sided ischial decubitus wound.


  • Stage IV ischial pressure ulcer with exposed bone and fibrinous slough.


  • Clean, pink granulation tissue at wound base with no evidence of gross contamination.

  • Multiple scars indicative of prior surgical management with likely posterior thigh and gluteal rotation flaps.


  • Risk factor assessment: Age, nutritional status, comorbid conditions (diabetes, vascular disease), ambulatory status, spinal cord injury, spasm and previous treatment, continence (urine and fecal), tobacco and substance abuse, presence of shear forces, mental status

  • Support network

    • For treatment and continued care.

    • Home environment and any pressure-reducing devices.

  • Current wound and skin care regimens.

  • Previous wounds and interventions.

  • History of current wound: Duration, previous infection, changes in size.

Physical examination

  • Location and dimensions of wound, quality of surrounding tissues, focused sensory examination.

  • Presence of spasm, moisture, soilage.

  • Evidence of infection.

  • Pressure ulcer staging (Table 31.1).

    Pressure ulcer staging




    Intact skin with nonblanching erythema, usually over a bony prominence.


    Partial-thickness dermal loss. Appears as a shallow open ulcer with a red–pink wound bed without slough, or as a serum-filled bullous lesion (intact or ruptured).


    Full-thickness tissue loss. Subcutaneous fat may be visible. Bone, tendon, or muscle is not exposed; these are prefascial wounds. May have undermining.


    Full-thickness tissue loss through the fascia with exposed bone, tendon, or muscle. Often includes undermining and tunneling.

Pertinent imaging or diagnostic studies

  • Laboratory tests: Complete blood count (CBC), complete electrolyte panel, albumin/prealbumin, hemoglobin A1C, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP).

  • Magnetic resonance (MR) imaging: Osteomyelitis is suggested by the presence of T2 hyperintensity and low intensity on T1 images; sensitive and specific for osteomyelitis.

  • Tissue biopsy: For pathology in chronic wounds and for culture.

    • Bone biopsy may be useful to rule out osteomyelitis, especially if suggested on MR imaging.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Ischial Pressure Sores

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