The greater trochanter is the projection which determines the site of the trochanteric ulcer. Initially, the main cavity of the ulcer is the trochanteric bursa which overlies the projection and, if this alone is involved, permanent closure may be achieved without interfering with the bone.
As the condition progresses the trochanter and neck of femur increasingly project into the cavity, and excision of trochanter and appropri-ate cortex of the shaft is required to let the soft tissues collapse and obliterate the cavity. In the most severe instances a pyoarthrosis of the hip joint may develop and, once present, this complica-tion is virtually impossible to eradicate without amputation of the limb.
The ulcer is so undermined in most cases that
free skin grafting is seldom practicable. Cover by a flap is necessary. When this takes the form of a skin flap a transposed flap is used; its precise situ-
ation and shape will depend on the size and shape of the ulcer, with the proviso always that the secondary defect should be on an area free from subsequent weightbearing.
Added safety can be provided by incorporating the iliotibial tract in the flap, in the form of a tensor fasciae latae myocutaneous flap.