臀部穿支皮瓣治疗老年患者骶尾部褥疮的疗效

目的探讨应用臀部穿支皮瓣治疗老年患者骶尾部褥疮的临床效果。方法 2005年1月-2010年6月,收治29例老年骶尾部褥疮患者。男16例,女13例;年龄61～75岁,平均68岁。病程5个月～10年,中位病程5.5年。根据美国国家褥疮顾问小组(NPUAP)标准分度:Ⅲ度褥疮11例,Ⅳ度18例。褥疮范围7 cm×6 cm～12 cm×10 cm。合并症:脑血管障碍8例,老年痴呆6例,截瘫11例,其他4例。术中采用大小为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。结果术后2 d 3例(10.3%)皮瓣远端出现部分坏死,其余患者皮瓣均顺利成活,创面Ⅰ期愈合,Ⅰ期愈合率为(89.7%)。供区切口均Ⅰ期愈合。术后1周2例(6.9%)褥疮基底发生感染,术后10 d 1例(3.4%)发生伤口裂开,均经对症处理后愈合。术后27例获随访,随访时间6个月～5年,平均3年。术后1、3年,2例褥疮复发,其中1例死于全身感染,1例行单纯清创缝合术后愈合;其余患者褥疮均未复发,皮瓣质地、颜色及弹性均恢复良好。结论臀部穿支皮瓣治疗老年患者骶尾部褥疮,只要严格掌握手术适应证,充分做好术前准备,早期手术,可取得良好的治疗效果。

Effectiveness of perforator flaps for elderly patients with ischia-sacral ulcers

Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers.Methods Between January 2005 and June 2010,29 elderly patients with ischia-sacral ulcers were treated.There were 16 males and 13 females,aged from 61 to 75 years(mean,68 years),including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel(NPUAP).The disease duration was from 5 months to ...