臀部穿支皮瓣结合负压封闭引流治疗骶尾部褥疮

目的 探讨负压封闭引流技术(VSD)结合臀部穿支皮瓣治疗骶尾部褥疮的应用效果. 方法 2009年1月至2011年5月,对骶尾部褥疮患者20例,褥疮范围7cm×6cm～12cm×10cm.一期实施清创手术后进行持续负压引流7～14d,同时进行控制感染、营养支持等全身治疗.二期采用大小为8 cm×6 cm ～ 14 cm × 12 cm的臀部穿支皮瓣修复创面,供区直接缝合.结果 经持续负压治疗后,患者局部炎性反应明显减轻,创面明显缩小,为二期手术提供了良好条件,再行二期穿支皮瓣修复,皮瓣除2例出现远端部分坏死外,均一期愈合.随访3个月～2年,褥疮无复发. 结论 正确应用VSD技术可有效减少褥疮感染和渗出、提高穿支皮瓣手术成功率,减少并发症.达到良好的治疗效果.     

穿支动脉皮瓣修复骶尾部褥疮 15 例

目的 探讨应用穿支动脉皮瓣修复骶尾部褥疮的手术方法及临床效果. 方法 2000年1月-2006年10月,收治15例骶尾部褥疮患者.男10例,女5例;年龄49～75岁.Ⅲ度褥疮6例,Ⅳ度9例.褥疮范围5 cm×4 cm～10 cm×8 cm.根据缺损部位及大小设计以臀上、骶旁或腰动脉皮穿支为血管蒂的轴型穿支蒂皮瓣移位修复骶尾部褥疮.采用旋转移位皮瓣修复 11 例,皮瓣周围完全切开的岛状皮瓣修复 4 例. 结果 术中出血50～300 mL,无需输血.手术时间 1～2 h,无特殊不适.术后皮瓣全部成活,13 例伤口Ⅰ期愈合,2 例出现血肿和感染,经换药后愈合.住院时间20～40 d,平均29 d.随访1～5年,皮瓣质地优良,外形满意.皮肤颜色及弹性均恢复较好,褥疮无复发. 结论 穿支动脉皮瓣设计灵活、切取方便、血供可靠、不损伤臀部肌肉、供区无需植皮,是修复臀骶部褥疮的理想方法.     

臀部皮瓣修复骶尾部、臀部、坐骨结节部压疮的临床应用

目的 探讨臀部皮瓣修复骶尾部、臀部、坐骨结节部压疮的临床效果。方法 自2016年7月至2022年7月,芜湖市第二人民医院整复烧伤科收治的压疮患者20例（骶尾部9例,臀部5例,坐骨结节部6例）;分别采用臀上动脉穿支皮瓣修复5例,压疮创面大小为3 cm×4 cm～8 cm×13 cm,皮瓣切取面积为4 cm×8 cm～9 cm×18 cm;臀下动脉穿支皮瓣修复7例,压疮创面大小为2 cm×4 cm～8 cm×12 cm,皮瓣切取面积为5 cm×10 cm～12 cm×20 cm;臀大肌肌皮瓣修复8例,压疮创面大小为4 cm×4 cm～11 cm×15 cm,皮瓣切取面积为8 cm×12 cm～12 cm×20 cm。结果 20例患者皮瓣全部成活,18例患者供瓣区直接拉拢缝合,均一期愈合,2例患者皮瓣术后裂开,经2期手术修复愈合,其中1例患者缩小供瓣区后行全厚皮片移植术,术后全厚皮片成活良好;1例患者缩小供瓣区后行中厚皮片移植术,术后皮片部分成活,残留少许肉芽创面经后期换药治愈。结论 臀部皮瓣血供丰富,外形美观,不臃肿,弹性佳,耐磨性较好,抗感染能力较强,是目前修复骶尾部、臀部、坐骨结节部压...     

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。     

应用臀上动脉穿支皮瓣联合负压封闭引流修复骶尾部压疮

目的 观察应用臀上动脉穿支皮瓣联合负压封闭引流修复骶尾部压疮的治疗效果.方法 对13例(20处)骶尾部压疮患者的创面(5 cm× 10 cm～ 14 cm×17 cm)均采用臀上动脉穿支V-Y推进皮瓣联合负压封闭引流术治疗.结果 本组共13例患者,术后20处臀上动脉穿支岛状皮瓣均成活,创面Ⅰ期愈合.随访6～48个月,其中1例患者复发,其余患者情况良好.结论 应用臀上动脉穿支V-Y推进皮瓣联合持续负压引流修复骶尾部压疮的方法,操作简单、安全、有效,值得临床推广应用.     

腰臀穿支筋膜皮瓣移位修复骶尾部压疮

目的 总结采用腰臀穿支筋膜皮瓣移位修复骶尾部压疮的临床疗效.方法 2003年3月-2007年11月,收治7例骶尾部Ⅲ度压疮.男5例,女2例:年龄35～75岁.高位截瘫2例,双下肢瘫痪5例.溃疡范围4.2 cm×3.5 cm～10.0 cm×7.3 cm.术中采用6 cm×4 cm～11 cm×8 cm腰臀穿支筋膜皮瓣移位修复.结果 术后皮瓣均成活,供、受区切口Ⅰ期愈合.患者均获随访,随访时间6～30个月.皮瓣质地和外观良好,压疮无复发.结论 腰臀穿支筋膜皮瓣解剖位置恒定、血供丰富,手术操作简便、安全,修复创面较大,是修复骶尾部压疮较为理想的方法.     

应用双侧臀上下动脉穿支皮瓣修复骶尾部巨大压疮

目的探讨采用双侧臀上、下动脉穿支皮瓣旋转修复骶尾部巨大压疮的临床效果。方法对8例骶尾部巨大压疮(15 cm×9 cm～18 cm×12 cm)患者,设计以双侧臀上、下动脉穿支为蒂的局部旋转皮瓣修复压疮创面,皮瓣切取面积30 cm×18 cm～45 cm×25 cm。结果所有皮瓣全部成活,其中6例切口一期愈合,2例切口延期愈合;术后随访1～3个月,压疮无复发,皮瓣弹性良好,双侧臀部基本对称。结论采用双侧臀上、下动脉穿支皮瓣旋转修复骶尾部巨大压疮,是一种简单可行的方法。     

筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面疗效观察

目的 探讨筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面的可行性和疗效。方法 2019年3月—2022年8月收治9例骶尾部藏毛窦患者，男7例，女2例；年龄17～53岁，平均29.4岁。病程1～36个月，中位病程6个月。伴有肥胖和毛发浓密者7例，感染3例，窦道分泌物细菌培养阳性2例。病灶切除后创面范围3 cm×3 cm～8 cm×4 cm，深度3～5 cm、达肛周或尾骨；伴有肛周脓肿形成2例，尾骨炎性水肿1例。术中扩大切除，设计并切取臀部左、右两侧筋膜组织瓣及皮瓣，范围均为3.0 cm×1.5 cm～8.0 cm×2.0 cm。创面底部放置“十”字引流管，筋膜组织瓣及皮瓣推进分3层缝合，即筋膜层“8”字缝合、真皮层内倒刺线减张缝合、皮肤间断缝合。结果 9例患者均获随访，随访时间3～36个月，平均12个月。所有切口均Ⅰ期愈合，无切口裂开、术区感染等并发症发生。均无窦道复发，臀沟外形满意，臀部两侧对称，局部切口瘢痕隐蔽，外形破坏最小。结论 筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面可有效填塞腔隙，降低切口愈合不良发生率，具有创伤小、操作简单的优点。     

创面床准备中使用重组人表皮生长因子后直接拉拢缝合修复骶尾部Ⅲ度褥疮

目的 探讨重组人表皮生长因子（recombinant human epidermal growth factor,rhEGF）加强创面准备后直接拉拢缝合修复骶尾部Ⅲ度褥疮的临床效果.方法 2007年1月至2009年10月,选择要求修复骶尾部Ⅲ度褥疮的就诊患者60例,褥疮面积3 cm×4 cm至10 cm×12 cm,病程15～70 d.随机均分为对照组和治疗组.治疗组创面除了常规换药外,还应用rhECF以强化创面准备;对照组创面仅常规换药,手术方式均为直接拉拢缝合.主要观察术后创面Ⅰ期愈合率及术后并发症发生率.结果 治疗组Ⅰ期愈合率达87%,术后并发症的发生率仅约13%;对照组术后Ⅰ期愈合率约70%,并发症的发生率达30%,两组间并发症与Ⅰ期愈合率分别比较,差异均具有统计学意义（P＜0.01）.结论 rhEGF强化创面准备后使后续手术治疗更加有效,不仅可以增加后续手术治愈率及减少术后并发症发生率,而且在筋膜层下便于剥离,血供充足.rhEGF联合直接拉拢缝合是一种简便、有效促进骶尾部Ⅲ度褥疮愈合的方法,尤其适合于高龄并且首次施行手术的患者.     

以臀上动脉浅支穿支血管为蒂分叶皮瓣修复骶尾部软组织缺损

目的探讨一种安全、有效、快速修复骶尾部软组织缺损和/或伴骨外露的方法。方法2003年2月～2006年4月,应用臀上动脉浅支穿支血管为蒂分叶皮瓣移位修复骶尾部巨大褥疮及软组织缺损6例。男4例,女2例,年龄28～67岁。骶尾部软组织缺损范围为15cm×12cm～25cm×20cm,平均20cm×16cm;褥疮5例,肿瘤1例;按褥疮分度度3例,度3例;病程3周～20年。切取分叶皮瓣范围为18cm×15cm～30cm×25cm。结果术后6例移位皮瓣均成活,其中5例切口期愈合,1例皮瓣周缘皮肤少量缺血、坏死,经间断换药32d后期愈合。随访2～38个月,平均19.3个月,分叶皮瓣生长良好,褥疮无复发,臀大肌保留良好伸髋功能。结论带臀上动脉浅支穿支血管为蒂分叶皮瓣是修复骶尾部软组织缺损和/或伴骨外露的一种有效方法,具有操作简便、皮瓣血运好、并发症少、成功率高等优点。     

The peripheral blood pressure in legs with venous ulcers.

Venous ulcers require effective compression treatment which is, however, contra-indicated in cases of arterial insufficiency. In elderly patients with typical venous ulcers the question arises whether they may have concomitant arterial insufficiency. In early studies is was proved that arterial insufficiency in the lower limbs may be diagnosed as a low systolic blood pressure in the great toe as compared with the systolic arm blood pressure. In the present investigation the systolic blood pressure in the great toe was measured in 48 patients with verified venous ulcers. The toe blood pressure and the pressure difference from arm to toe were studied and compared with the corresponding values in normal subjects. 35 patients had no evidence of arterial insufficiency, but in 13 cases signs of concomitant arterial insufficiency was found. The method of measuring the systolic blood pressure in the toes seems to be a simple and reliable method for estimating the degree of arterial insufficiency even in patients with chronic venous disease.     

Association Between Low Admission Norton Scale Scores and Postoperative Complications After Elective THA in Elderly Patients

The Norton scoring system is used by nurses to evaluate pressure ulcer risk. The authors have previously shown that low admission Norton scale scores (ANSS) are associated with postoperative complications other than pressure ulcers following hip fracture and spine fracture surgery in elderly patients. The purpose of this retrospective, cross-sectional study study was to determine whether low ANSS are associated with postoperative complications other than pressure ulcers following elective total hip arthroplasty (THA) in elderly patients. The medical charts of consecutive elderly (older than 65 years) patients admitted between February 2008 and November 2010 were studied for acute renal failure, cardiovascular events, confusion, pneumonia, pressure ulcers, urinary infection, urinary retention, venous thromboembolism, wound infection, and other complications. The final cohort included 166 patients (108 [65.1%] women; aged 75.2±6.4 years). Overall, 24 (14.5%) patients had low (16 or less) ANSS. Patients with low ANSS had significantly more postoperative complications other than pressure ulcers compared with patients with high ANSS (0.5±0.7 vs 0.2±0.4, respectively; P=.018). Binary regression analysis showed that low ANSS were independently associated with all postoperative complications other than pressure ulcers (P=.039).In addition to predicting pressure ulcer risk, the Norton scoring system may be used for predicting other postoperative complications in elderly patients following elective THA.     

Outcomes for surgical coverage of pressure sores in nonambulatory,nonparaplegic, elderly patients

Pressure sores are a common complication of long-term institutional care. Surgical coverage of late-stage ulcers in the elderly refractory to conservative therapy remains controversial. The authors reviewed the outcome of 22 predominately nonambulatory, nonparaplegic, elderly patients with coverage of 27 pressure sores. The mean patient age was 59 years (range, 50-82 years). The average follow-up was 6 months (range, 3 months-2 years). There were 11 complications for the 22 patients (50%) and the 27 ulcers (41%). Postoperatively, a well-healed ulcer was present in 19 of 27 patients (70%) at 6 months. Of the 19 reconstructed sacral ulcers, there were 10 complications (53%) and one recurrence at 6 months. Seven trochanteric ulcers were covered with tensor fascia lata flaps without complications or recurrences at the 6-month follow-up. One ischial ulcer was managed using a V-Y hamstring advancement flap, resulting in dehiscence and a subsequent revision. The authors advocate surgical coverage to treat late-stage pressure sores in nonparalyzed elderly persons to reduce the morbidity, mortality, and economic burden of patients with late-stage pressure ulcers. With an increasing geriatric population, prevention and postoperative care are necessary to diminish the incidence, recurrence, and burden of pressure sores.     

Penetrating atherosclerotic ulcers of the aorta

Purpose: This study investigates the natural history and optimal imaging modality of penetrating atherosclerotic ulcers of the aorta.Methods: We reviewed our experience with 29 penetrating ulcers in 18 patients. Computed tomography (17 patients), magnetic resonance imaging (nine patients), and aortography (five patients) were used for diagnosis and follow-up. Patients were typically elderly (average age 74 years) and had hypertension and coronary artery disease. Ulcers were most common in the distal descending thoracic aorta (31%) and were characterized by a discrete ulcer crater (100%) and thickened aortic wall (89%). Modes of presentation included chest or back pain in four patients, distal embolization in two patients, and abnormal chest radiography results in one; the remaining were incidental findings.Results: Follow-up was available in ten patients with 17 ulcers from 1 to 7 years. Recurrent pain occurred in two patients, recurrent embolization occurred in one patient, and seven patients remained symptom free. Progression to saccular pseudoaneurysm occurred in five ulcers, and fusiform aneurysm occurred in two ulcers. Two ulcers were associated with an increase in aortic diameter, and nine ulcers did not change. There were no cases of aortic dissection or rupture in the follow-up period. There were no deaths and only one patient underwent resection.Conclusion: The natural history of penetrating atherosclerotic ulcers is one of progressive aortic enlargement, with saccular and fusiform aneurysms the result if follow-up is sufficient. Aortic dissection, aortic rupture, and embolization can also occur but are less common. Contrast-enhanced computed tomography is the primary imaging modality. (J VASC SURG 1994;19:90-9.)     

Surgical treatment of perforative gastroduodenal ulcers in elderly and senile patients

The work is based on experiences with surgical treatment of 206 elderly and senile patients with perforating gastroduodenal ulcers. In 67.5% of cases the perforations took place in duodenal ulcers, in 16%--in the pyloric canal. The gastric body and antral portion ulcers were perforative more rarely--9.8% and 4.8% respectively. Perforations of the cardial and retrobulbar ulcers were found in 1.9% and 1% respectively. At early terms after operation 67 patients (33.5%) died. After suturing the perforative opening 38 out of 98 patients died (38.8%), after dissection and suturing the ulcers died 7 out of 19 patients, after Oppel-Polikarpov operation died 7 out of 11, after resection of the stomach died 4 out of 6, after truncal vagotomy with pyloroplasty died 11 out of 72 patients (15.3%). The main cause of lethal outcomes is thought to be complications of the coexistent diseases, totally responsible for 46.2% of deaths. Truncal vagotomy with a dissection of the ulcer and pyloroplasty performed in 60-70 year old patients gave the least indices of lethality and early postoperative complications, so the indications to radical organ-saving operations in patients of this age must be wider. This method of treatment for perforative ulcers in patients of 71-80 years of age should be used with restrictions due to not bad long-term results of suturing the ulcers (good and excellent results took place in 53.8% of cases). In patients older than 80 radical operations are not indicated. In such cases the ulcer should be better dissected and sutured, the posterior wall of the organ being examined for a "mirror" ulcer.     

Giant stomach ulcers

The authors analyse the results of endoscopy in 127 patients and clinical observations over 98 patients with giant ulcers of the stomach. The study provided evidence of the low frequency of giant ulcers, their marked polymorphism, and tendency to bleed and degenerate. These ulcers do not differ from the usual ulcers in the values of the secretory activity of the stomach and the duodenogastric reflux, but possess characteristic morphologic criteria. Giant ulcers are marked by higher operative mortality and the late-term results of surgical treatment of these patients yield to those in cases of usual gastric ulcers. Giant ulcers occur most frequently in the elderly.     

Complex treatment of trophic leg ulcers]

During the recent 4 years, 135 patients (130 females and 5 males) with trophic persistent ulcers of the lower extremities, developed due to venous pathology, were treated conservatively. Eighty patients aged from 30 to 50 years, and only 55 patients were much older. The duration of the disease was from 6 months to 20 years. Ulcers were of different size from 3.2 to 180 cm2. The combined method of treatment of trophic ulcers enabled the authors to shorten twice the terms of the treatment as compared with other methods. The positive effect was gained in 89.6% of cases, in 59 patients (43.7%) complete healing of ulcers being gained. This method may be employed not only under stationary but also under outpatient conditions.     

The results of the endoscopic diathermy coagulation of hemorrhaging gastroduodenal ulcers]

The authors analysed the results of endoscopic diathermy coagulation of bleeding acute gastroduodenal ulcers in 83 patients; in 47 of them the follow-up period ranged from 12 months to 9 years. A stable hemostatic effect was achieved in the early periods after coagulation of the acute ulcers in 76% of cases. The frequency of recurrent bleeding was found to be directly dependent on the degree of the blood loss. Recurrent bleeding from acute ulcerations of the gastric mucosa in the late-term period was discovered authentically in only one patient. It was linked with medication with brufen for a long duration. Thus, endoscopic diathermy coagulation produced good results in arresting bleeding from acute gastroduodenal ulcers, particularly in patients with a very high operative risk.     

Stump ulcers and continued prosthetic limb use

Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely affect the ulcer nor prevent healing. The survey would also form a basis for developing future guidelines in the management of stump ulcers. All consecutive patients attending the Chapel Allerton Hospital prosthetic clinic between January 2003 and May 2004 with stump ulcers were recruited into the study. Primary outcome measures were changes in the surface area of the ulcers and in clinical photographs taken on 2 occasions 6 weeks apart. Some 102 patients with a mean age 60 years (range 18 - 88 years) were recruited. Eight patients who were established prosthetic limb users did not complete the study and were excluded from the analysis. Of the patients 52 were newly referred patients with delayed surgical wound healing while 42 were established prosthetic limb users for at least 1 year. Continued prosthetic limb was associated with a significant reduction in ulcer size (p < 0.05). Mean sizes of the ulcers at first and second observations were 3.30 cm2 (range 0.06 - 81) and 0.70 cm2 (range 0.00 - 13.00) respectively. The ulcers improved in 83 cases while two were unchanged. Deterioration was observed in nine cases. The current clinical practice is to allow most of the patients to commence or continue prosthetic limb wearing despite the presence of stump ulceration. This observational study found that, despite prosthetic use, 60 (64%) cases healed completely within the six-week study period and 23 (25%) ulcers reduced in size. The ulcers were unchanged in 2% of the cases. Deterioration was observed in nine (9%) cases. This survey suggests that the current practice of allowing patients to use their prostheses is safe. A clinical trial is now needed to establish whether this practice alters healing rate or has any other disadvantages for new or established amputees.     

Surgery of the superficial venous system in elderly patients

Chronic venous insufficiency, which traditionally has been attributed to failure of the deep venous system, may result from reflux in the superficial venous system. Chronic venous insufficiency is common in elderly patients, but surgical treatment is seldom offered to this patient population. We evaluated the results of superficial venous surgery for the treatment of severe chronic venous insufficiency in a cohort of elderly patients. The authors assessed patients aged 70 years or more with chronic venous insufficiency that had failed conventional conservative treatment. The superficial and deep venous systems were thoroughly investigated by duplex ultrasonography. Associated medical conditions were reevaluated and their treatment optimized. Twenty-eight patients (11 men, 17 women), aged between 70 and 89 years (mean 79), underwent superficial venous surgery. Open ulcers, active dermatitis and recurrent erysipelas were evident in 12, 9 and 7 patients, respectively. Limb swelling and severe pain were present in 25 (89%). The operations were performed under general or regional anesthesia with overnight hospitalization. Surgical treatment consisted of ligation of the points of reflux at the junctions of the superficial and deep systems, as defined by the duplex examination (21 saphenofemoral junctions, 5 saphenopopliteal junctions, 10 perforator veins), and stripping of the long saphenous vein to knee level (15 patients). Postoperative ambulatory treatment was continued until the wounds were completely closed. All ulcers healed completely within 8 weeks. No cardiac, respiratory, or renal complications were encountered. Wound infection at the groin occurred in 1 patient. Cellulitis of the calf area developed in 4 patients. Two ulcers recurred during follow-up of 1 to 5 years (mean 2.5). Surgery of the superficial venous system for treatment of severe chronic venous insufficiency is effective and can be achieved with minimal morbidity in selected elderly patients. The risk/benefit ratio for this procedure has been reduced sufficiently to ensure a major improvement in the quality of life of such patients.