Surgical Ulcer Debridement in a Patient With Spina Bifida Complicated by Osteomyelitis, Obesity, and Diabetes.

The combination of obesity, diabetes mellitus (DM), and reduced mobility due to spina bifida can contribute to an increased risk of osteomyelitis. Spina bifida, a congenital defect of the spinal cord, causes vertebral column deformities and neurological impairment. Obesity can lead to increased pressure and stress on the bones and joints, as well as poor circulation and immune dysfunction, including neutrophil migration disorders. Similarly, DM can also contribute to poor circulation and inadequate immune function. These changes can increase the risk of neuropathic ulcerations and osteomyelitis. We report a case of a 59-year-old man who presented for surgical consultation at the inpatient care unit. He had a nonhealing sacral ulcer on the left buttock that persisted for a year. He had a history of spina bifida, type 2 DM, and anemia, and his body mass index was 57.6 kg/m2 . Physical examination revealed an unstageable left buttock pressure ulcer. The patient was afebrile, and his laboratory findings and imaging results indicated osteomyelitis. Despite intravenous antibiotic treatment, healing of the sacral ulcer remained poor, and the patient experienced chronic pain. Subsequent surgical intervention in the operating room involved debridement of the skin and soft tissue using high-powered water via the VERSAJET™ Hydrosurgery System (Smith & Nephew, London, UK). Ulcerated and necrotic skin and subcutaneous tissue extending deeper than the muscles and bones were observed. Loop colostomy was performed after determining that the wound would not heal owing to its proximity to the rectum and the inevitable contamination with stool. Postoperatively, sacral bone biopsy confirmed osteomyelitis. Alternative treatment options remained limited, as several other treatment methods failed prior to surgical debridement and colostomy placement. Although repeated debridement improved tissue viability, loop colostomy was performed to divert stool and prevent contamination of the ulcer.