Unique surgical approach for Ischial pressure ulcers in transverse myelitis patient

Pune: In a remarkable medical case, Viraj Hande (name changed), a patient diagnosed with Transverse Myelitis, has undergone a groundbreaking surgical procedure to address Grade 4 Bilateral Ischial Pressure Sores. The patient’s inspiring journey from being bedridden to being employed as an IT professional underscores the resilience of the human spirit.

The patient, originally from Beed, relocated to Pune 1.5 years ago for work. Despite being confined to bed due to Transverse Myelitis, he secured employment as an IT professional and has been working in a hybrid capacity for the past 1.2 years. Unfortunately, his job’s prolonged sitting requirements led to the development of ischial pressure ulcers on both sides. Remarkably, he had not experienced such sores while bedridden.

Due to the loss of sensation caused by Transverse Myelitis, the patient was unaware of the ulcers until they progressed to a critical stage measuring 13cm12cm10cm. Dr Sarang Kulkarni, Consultant - Internal Medicine, Sahyadri Hospitals said, “The patient was admitted to our hospital on December 15, 2023, presenting with abdominal pain, dysuria, and other symptoms. His medical history included Transverse Myelitis, UTI, and Duodenitis. Due to Transverse Myelitis, the patient had motor weakness, sensory impairments, and autonomic dysfunction. We treated this patient conservatively for his UTI, and abdominal pain with antibiotics and anti-inflammatory medicines.”

The surgical procedure involved cleaning both wounds, removing tissue, and utilising a hatchet flap to cover the sores on both sides of the body. The hatchet flap, resembling the blade of a small axe, narrows where the handle is fastened and has a narrow base for increased freedom of movement. Additionally, an osteotomy (bone-cutting procedure) and bursectomy (removal of an infected bursa) were performed. These steps aimed to alleviate pressure and prevent the recurrence of pressure ulcers. The surgery took place on December 21, 2023. Notably, this unique approach ensured optimal cosmetic and functional outcomes, offering faster relief and smoother recovery compared to traditional methods like air beds and frequent position changes.

Dr Pushkar Deshpande, Cosmetic surgeon said, “Despite being only 29 years old, the patient developed ischial pressure sores—a condition typically associated with elderly malnourished individuals. While Transverse Myelitis played a role, the primary cause of the sores was prolonged sitting, setting this case apart. Remarkably, the patient developed pressure sores on both sides, and they were surgically treated in a single session—a groundbreaking procedure in India. During the precise surgery the underlying cause, pressure on bony prominences—was effectively addressed. The innovative use of a skin hatchet flap further enhanced the outcome.

This case represents a pioneering achievement, as it is the first in India to treat Bilateral Ischial Pressure Ulcers using a Bilateral Hatchet Flap in a single setting—an accomplishment not previously reported. This inventive flap design prioritises both aesthetics and functionality, revolutionising the approach to complex pressure sore cases."