可灌洗负压封闭引流技术联合岛状臀大肌皮瓣修复Ⅳ度褥疮

目的 探讨使用可灌洗负压封闭引流联合岛状臀大肌皮瓣移植对Ⅳ度褥疮的治疗效果. 方法 2009年10月至2011年3月收治的35例骶尾部Ⅳ度褥疮患者,所有创面进行彻底清创后应用可灌洗负压封闭引流装置,7 ～10 d后,拆除装置,根据创面情况选择合适的皮瓣修复:17例使用一侧岛状臀大肌推移皮瓣修复,6例使用双侧岛状臀大肌推移皮瓣修复,12例使用岛状臀大肌旋转皮瓣修复. 结果 35例应用可灌洗负压封闭引流患者在使用1～2次,10 ～ 21 d(平均15.6 d)内控制感染,全部病例皮瓣一期成活,创面消失,供区成活良好,平均治疗时间35 d;所有病例完成3～6个月随访,仅1例患者再次出现Ⅱ度褥疮. 结论 可灌洗负压封闭引流技术联合岛状臀大肌皮瓣是修复Ⅳ度褥疮合并感染的有效方法.     

负压封闭引流技术配合臀大肌皮瓣移植治疗骶尾部褥疮

目的 探讨负压封闭引流技术( VSD)配合臀大肌皮瓣移植治疗骶尾部褥疮的效果。 方法 15例骶尾部褥疮先行清创及封闭负压吸引,7～10 d后二期应用臀大肌皮瓣移位修复创面。结果 15例骶尾部褥疮经负压封闭引流7～ 10d后,感染控制,创面肉芽组织新鲜或部分骨外露,二期移植组织瓣13例全部成活,2例边缘少许表皮坏死,经换药后愈合。 结论 负压封闭引流可以控制感染,促进肉芽组织生长,配合臀大肌皮瓣移植治疗骶尾部褥疮,效果良好。     

多发性压力性溃疡的外科治疗

目的 总结多发性压力性溃疡的治疗经验. 方法 2001年1月-2007年5月,笔者应用多种皮瓣转移联合皮肤移植治疗21例患者的56处压力性溃疡创面,其中骶尾部21处、坐骨结节14处、股骨大转子部13处、其他部位8处.围手术期行全身支持治疗,尽早清创,依据扩创后创面大小、深度、部位及邻近皮肤软组织条件,选用皮瓣、肌皮瓣或游离植皮修复创面.术后对伤口行连续灌洗与负压吸引,卧翻身床定期翻身. 结果 25处创面以筋膜皮瓣或肌皮瓣修复,愈合率为92%;13处创面以邻近局部皮瓣修复,愈合率为85%;8处创面直接缝合,其中6处一次性愈合;10处创面游离植皮,其中7处一次性愈合.在延期愈合的创面中,4处经再次清创缝合或植皮愈合,4处经短期换药愈合,1例遗留慢性窦道.随访6个月时,3例患者复发压力性溃疡. 结论加强围手术期全身支持治疗,合理、有效地利用臀部及其周围健康组织形成多个筋膜皮瓣或肌皮瓣同时修复多个创面,术后对伤口行连续灌洗与负压吸引,采用翻身床定期翻身等等,是多发性压力性溃疡手术成功的有效措施.     

负压封闭引流结合臀大肌肌皮瓣在骶尾部褥疮修复中的应用

[目的]探讨负压封闭引流(VSD)结合臀大肌肌皮瓣修复骶尾部褥疮的临床效果.[方法]选择2005年2月～2009年2月收治的骶尾部褥疮患者31例,男17例,女14例;年龄30～ 75岁,病程0.2 ～20年.创面面积:5cm×6.5cm～8cm×12.5cm.随机分为两组:治疗组16例,创面先经负压封闭引流处理,设计以臀上动脉浅支为血管蒂的臀大肌上部肌皮瓣,修复骶尾部褥疮.对照组15例,常规换药处理后臀大肌上部肌皮瓣修复.[结果] 29例患者皮瓣一期存活,试验组和对照组各有1例皮瓣远端部分坏死,经换药后愈合.治疗过程中无大出血、血管神经损伤、感染等并发症.所有患者均获随访,随访时间12 ～18个月,肌皮瓣质地良好,褥疮无复发,功能满意.试验组在换药次数、住院时间及抗生素使用等方面优于对照组,差异有统计学意义(P＜0.01).[结论]应用负压封闭引流结合臀大肌肌皮瓣修复骶尾部褥疮,能够明显缩短病程,并发症少,成功率高,是治疗骶尾部褥疮的理想方法之一.     

臀大肌肌皮瓣联合真皮皮瓣修复骶尾部褥疮

目的总结采用臀大肌肌皮瓣联合真皮皮瓣修复骶尾部褥疮的临床疗效。方法 2003年1月-2010年9月,收治骶尾部褥疮33例。男14例,女19例;年龄22～79岁,平均56岁。病程5个月～7年。创面直径为4～12 cm,平均7 cm;周围均伴有1～4 cm潜行腔隙。褥疮按照四度分类法:Ⅲ度8例,Ⅳ度25例。术中切取大小为8 cm×5 cm～13 cm×9 cm的臀大肌肌皮瓣旋转修复创面,并切去肌皮瓣远端表皮,形成真皮皮瓣填塞于潜行腔隙内。供区直接缝合。结果术后2例出现皮瓣远端水肿,1例负压引流失效,均经对症治疗后创面愈合。其余患者皮瓣顺利成活,供、受区切口均Ⅰ期愈合。术后31例获随访,随访时间6～12个月,平均9个月。4例复发,1例局部炎症复发;其余26例患者无复发,皮瓣愈合良好。结论采用臀大肌肌皮瓣联合真皮皮瓣具有手术操作简便,术后皮瓣成活率高、耐磨,复发率低的优点,是修复骶尾部褥疮的有效方法之一。     

负压封闭引流治疗骶尾部褥疮创面的疗效观察

目的:探讨负压封闭引流技术治疗骶尾部褥疮创面的临床应用效果。方法:选择2011年9月~2013年12月在我科就诊并用负压封闭引流治疗的24例褥疮患者,对患者的治疗及愈后进行统计分析。结果:24例骶尾部褥疮创面患者肉芽组织生长良好,符合皮片或皮瓣移植的条件,经Ⅱ期手术到达均彻底愈合,愈合时间平均为14~31天,平均住院治疗35.6天。结论:负压封闭引流治疗骶尾部褥疮创面疗效显著、愈合快、住院时间短、费用低,在减轻患者疼痛、改善预后等值得推广。     

负压封闭引流后应用皮瓣移植治疗开放性骨折创面

目的 探讨负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面的效果.方法 30例GustiloⅢB、ⅢC型开放性骨折急诊先行清创,根据骨折类型,选用克氏针、螺钉简单内固定,必要时再用外固定支架固定骨折端,应用负压封闭引流(VSD)7～10 d,行皮瓣移植消灭创面,根据创面大小和周围皮肤软组织损伤情况,选用局部随意皮瓣8例,外踝上穿支皮瓣2例,腓肠神经营养皮瓣5例,股前外侧皮瓣15例.结果 30例皮瓣成活,无感染,术后随访1～2年,皮瓣质地良好,X线片示术后4～10个月,平均7个月均达骨性愈合,无骨髓炎征象.结论 负压封闭引流可以免除换药、刺激肉芽组织生长,保持肌腱、骨质新鲜,为二期行皮瓣移植永久闭合创面提供了良好的条件.负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面可获得较好的修复效果.     

负压封闭引流后应用皮瓣移植治疗开放性骨折创面

目的 探讨负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面的效果.方法 30例GustiloⅢB、ⅢC型开放性骨折急诊先行清创,根据骨折类型,选用克氏针、螺钉简单内固定,必要时再用外固定支架固定骨折端,应用负压封闭引流(VSD)7～10 d,行皮瓣移植消灭创面,根据创面大小和周围皮肤软组织损伤情况,选用局部随意皮瓣8例,外踝上穿支皮瓣2例,腓肠神经营养皮瓣5例,股前外侧皮瓣15例.结果 30例皮瓣成活,无感染,术后随访1～2年,皮瓣质地良好,X线片示术后4～10个月,平均7个月均达骨性愈合,无骨髓炎征象.结论 负压封闭引流可以免除换药、刺激肉芽组织生长,保持肌腱、骨质新鲜,为二期行皮瓣移植永久闭合创面提供了良好的条件.负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面可获得较好的修复效果.     

负压封闭引流后应用皮瓣移植治疗开放性骨折创面

目的 探讨负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面的效果.方法 30例GustiloⅢB、ⅢC型开放性骨折急诊先行清创,根据骨折类型,选用克氏针、螺钉简单内固定,必要时再用外固定支架固定骨折端,应用负压封闭引流(VSD)7～10 d,行皮瓣移植消灭创面,根据创面大小和周围皮肤软组织损伤情况,选用局部随意皮瓣8例,外踝上穿支皮瓣2例,腓肠神经营养皮瓣5例,股前外侧皮瓣15例.结果 30例皮瓣成活,无感染,术后随访1～2年,皮瓣质地良好,X线片示术后4～10个月,平均7个月均达骨性愈合,无骨髓炎征象.结论 负压封闭引流可以免除换药、刺激肉芽组织生长,保持肌腱、骨质新鲜,为二期行皮瓣移植永久闭合创面提供了良好的条件.负压封闭引流后应用皮瓣移植治疗GustiloⅢB、ⅢC型开放性骨折创面可获得较好的修复效果.     

难愈性创面的外科治疗

目的:总结修复难愈性创面的治疗经验.方法:2003年1月～2007年12月,采用不同的修复方法治疗67例难愈性创面,对其临床治疗与随访资料进行分析总结.结果:除2例胫骨凿孔,培养肉芽组织后植皮完全坏死外,板障层移植皮片与短管状骨面植皮片、皮瓣100%成活,伤口Ⅰ期愈合;对于存在数月至数年的糖尿病足、下肢静脉曲张后溃疡的患者,在全身情况维持稳定的同时,应用简易封闭负压治疗技术,创面局部改善后,行皮瓣或皮片移植术,皮瓣、皮片成活良好.经术后2～12月随访,创面愈合良好,功能恢复满意.结论:短管状骨骨髓面或板障层植皮、多种皮瓣以及封闭负压引流技术综合运用可较好治疗难愈性创面.     

Myocutaneous flap in the treatment of pressure sores

Thirty cases of large pressure sores were treated by myocutaneous flaps (39 flaps) and the cure rate was 92%. Of them, 15 pressure sores were treated by gluteus maximus myocutaneous flaps, 12 in the greater trochanteric area by tensor fascia lata myocutaneous flaps, 7 in the ischiatic area by gracilis myocutaneous flaps and 4 in the ischiatic area biceps femoris myocutaneous flaps, 2 by a abductor hallucis myocutaneous flap and a flexor digitorum brevis myocutaneous flap. In author's opinion, myocutaneous flap transposition is simple, safe and reliable method in treating large pressure sores. These flaps increased the blood flow on recipient sites through its own intrinsic blood vessels so as to accelerate wound healing.     

Comparative study of 2 surgical techniques in the treatment of ischial pressure ulcers in paraplegic patients. Retrospective study of 90 cases

This is a retrospective study concerning 90 paraplegic or tetraplegic patients with ischial pressure sores. Sixty-two patients were treated by gluteus maximus musculocutaneous island flap and 28 by VY hamstring myocutaneous flap. The authors describe the surgical technique of the two flaps. It is a one time surgery (excision and flap). There were 25% immediate complications for the patients who had VY hamstring myocutaneous flap and 27% for those who had gluteus maximus musculocutaneous island flap. There were 35% mid- and long-term recurrences with VY hamstring myocutaneous flap and 50% with gluteus maximus musculocutaneous island flap. The authors now use the gluteus maximus island flap for the small pressure scores and the VY bomstring flap for the big one which are near the anus.     

Myokutane Lappen als sichere Defektdeckung bei höhergradigen pelvinen Dekubitalulzera Einteilung, Therapiekonzept und Darstellung des eigenen Krankenguts aus 16 Jahren

Infected pelvic pressure sores of Campbell stages IV–VII require soft tissue reconstruction, which means stable, multi-layered filling cover of the defect and reliable prophylaxis of relapse. Myocutaneous flaps meet these conditions well. Depending on the extent and the area of the sore, with predilection for the sacrum, the ischial tuberosity and the femoral trochanter, the gluteus maximus, biceps femoris and tensor fasciae latae muscles are most often used for myocutaneous flaps. Primary sutures, split skin grafts or local fasciocutaneous flaps are often sufficient treatment for smaller, superficial defects. Between 1981 and 1996, 133 patients (average age 50 years) with 212 pelvic pressure sores of all stages were treated in our clinic. After radical decubitus excision with pseudotumor technique and resection of the osseous prominences, one-stage reconstruction of solitary as well as multiple defects was performed with myocutaneous flaps in 135 cases. The postoperative general complication rate for all treatments was about 10–30%. With regard to the muscle flaps, one third healed without any problems, partial flap necrosis occurred in 6% and there was total loss of flap in 2% of all myocutaneous flaps. According to present knowledge, myocutaneous flaps seem to be the most reliable method for definitive covering of deep pelvic pressure sores, independent of the cause of the ulcer.     

穿通支皮瓣修复臀骶部褥疮的临床疗效

目的观察及评价采用穿通支皮瓣修复臀骶部褥疮的临床疗效。方法对26例臀骶部褥疮患者，按照缺损创面的位置和大小分类设计臀部、骶部穿通支岛状皮瓣或穿通支推进皮瓣进行修复。所切取皮瓣最大面积达20cm×15cm，穿通支外径在1．1mm以上，游离穿通支血管蒂长度为2．0～3．5cm。结果患者行皮瓣移植术后无皮瓣坏死、创面感染、瘘管形成等术后并发症，创面愈合较快。出院后随访患者6～24个月，皮瓣质地柔软，外形满意，局部褥疮未复发。结论穿通支皮瓣设计灵活、切取方便、血供可靠、不损伤臀部肌肉，供区大部分能直接缝合，是修复臀骶部褥疮的良好办法。     

A proposed protocol for the surgical treatment of pressure sores based on a study of 337 cases

Pressure sores are very common complications following spinal cord injuries and other neurological problems. We present out 15 years' experience in treating pressure sores with myocutaneous flaps. Each anatomical site is considered, divided into those in which cover was successful and those with recurrences. Over the past 8 years careful preoperative planning has been used and specific flaps for each anatomical area. Our home care system is organized to cover both domestic and medical problems. Treatment is determined after examining the wound (anatomical site, staging, infection) and underlying medical, nutritional, and neurological problems. The first choice for ischial ulcers is the VY advancement hamstring myocutaneous flap, sacral ulcers a VY myocutaneous advancement flap of gluteus maximus muscle, and for trochanteric ulcers the myocutaneous rotation flap of tensor fascia lata muscle. Using this protocol the treatment outcome of sacral and ischial ulcers has been encouraging, but in trochanteric ulcers the results have been less satisfactory. This experience supports the use of these flaps in the treatment of pressure sores in para and tetraplegic patients.     

Repair of bedsores and ulcers with gluteus maximus musculocutaneous flap]

From 1984 to 1991, 5 cases of bedsores and 1 case of ulcer resulted from irradiation in gluteal region were repaired with gluteus maximus musculocutaneous flaps. All 5 cases of bedsores were the result of paraplegia. After a myocutaneous flap was transferred, the donor area was directly sutured without skin grafting. The excision wound in one patient reached 18 cm x 12 cm in size, however it was still repaired with total gluteus maximus musculocutaneous flap, and the donor area was also immediately closed with sutures. All of the patients were healed by first intention. For non-paraplegic patients it was deemed contra-indicated to use a total maximus gluteus musculocutaneous flap, and instead one half of the muscle was used, in order to avoid impairment of function of the hip joint.     

Gluteus maximus myocutaneous flap cover for sacral radiation ulcers

Myocutaneous flap cover of postirradiation ulcers has recently been recognized as a useful and effective method of treating these non-healing ulcers. This study presents the results of three cases of postirradiation sacral ulcers treated by gluteus maximus myocutaneous flaps. In one case a conventional island flap was used, whereas in the other two cases a new technique of a total rotation gluteus maximus myocutaneous flap is described.     

Management of sacral pressure sores with a myocutaneous flap

Sacral ulcers usually are caused by pressure leading to pathologic changes in the layers of tissue extending from the skin to the bone. This type of ulcer occurs most commonly in paraplegic or unconscious patients. In a series of 25 patients with sacral pressure sores studied during a one year period of time, the initial management consisted of conservative treatment with excision of the ulcer and daily dressing changes. The results with this method of treatment were satisfactory in ten cases and unsatisfactory in 15 cases. The 15 cases in which the results were unsatisfactory then underwent treatment with operative methods including excision of the ulcer and primary closure, myocutaneous flaps, skin grafting, and transcutaneous skin flaps. In six of ten cases in which a myocutaneous flap was used, the wounds healed satisfactorily. In four cases an infection occurred; in three of these cases the wound healed after infection control, while skin grafting was required for the fourth patient. Overall, the postoperative results with the use of a myocutaneous flap were satisfactory, and the results also were good at follow-up.