术前负压封闭引流联合局部旋转皮瓣修复骶尾部压力性损伤的临床疗效分析

目的分析术前负压封闭引流联合局部旋转皮瓣修复骶尾部压力性损伤的临床疗效。 方法选取2014年6月至2017年12月苏州大学附属第一医院烧伤整形科收治的48例压力性损伤患者，男32例，女16例，按随机数字表法分为观察组(n＝24)和对照组(n＝24)。对照组入院后给予床边清创后每日换药，观察组入院后给予床边清创及负压封闭引流治疗。2组患者于入院治疗5～7 d后均行局部旋转皮瓣术及负压封闭引流修复骶尾部压力性损伤，同时睡悬浮床，局部旋转皮瓣术后1周去除负压材料同时予以创面换药直至愈合。比较2组患者术后2周甲、乙级愈合率，皮瓣坏死率，伤口裂开率及愈合时间、住院时间。数据比较采用t检验与Fisher确切概率法检验。 结果术后2周，观察组甲级愈合患者8例，乙级愈合患者12例，丙级愈合患者4例；对照组甲级愈合患者3例，乙级愈合患者11例，丙级愈合患者10例；观察组的甲、乙级愈合率83.33%(20/24)]与对照组58.33%(14/24)]相比，差异无统计学意义(P＝0.080)。术后2周，观察组2例患者皮瓣远端静脉淤血后部分坏死，7例患者拆线时伤口裂开；对照组9例患者存在皮瓣部分坏死，14例患者拆线时伤口裂开；均予以换药后愈合。观察组患者的术后皮瓣坏死率、术后伤口裂开率为8.33%(2/24)、29.17%(7/24)，优于对照组37.50%(9/24)、58.33%(14/24)]，差异均有统计学意义(P＝0.036、0.005)。观察组患者愈合时间、住院时间分别为(21.5±3.0)、(32.2±3.1) d，与对照组(24.3±2.4)、(35.7±3.3) d]相比，差异均有统计学意义(t＝3.565、3.719，P值均小于0.01)。全部48例患者术后随访2～6个月，患者皮瓣均存活良好，压力性损伤均未复发。 结论应用术前负压封闭引流联合局部旋转皮瓣修复骶尾部压力性损伤能显著提高患者临床疗效，降低患者住院时间、愈合时间及术后并发症发生率。48例患者术后随访2～6个月，患者皮瓣均存活良好，压力性损伤均未复发。

Clinical effect analysis of preoperative vacuum sealing drainage combined with local rotating skin flap for repairing sacrococcygeal pressure injury

ObjectiveTo analyze the clinical effect of preoperative vacuum sealing drainage combined with local rotary flap to repair sacrococcygeal pressure injury. MethodsFrom June 2014 to December 2017, 48 patients with pressure injury admitted to Department of Burns and Plastic Surgery, First Affiliated Hospital of Soochow University were selected, including 32 males and 16 females. The patients were divided into observation group (n=24) and control group (n=24) according to random number table method. After admission, the patients of control group were given bedside debridement and daily dressing change, while the patients of observation group were given bedside debridement and vacuum sealing drainage treatment. After 5 to 7 days of admission treatment, both groups were treated with local rotation flap and vacuum sealing drainage treatment and drainage to repair the sacrococcygeal pressure injury, while sleeping in a floating bed. One week after local rotation flap, vacuum sealing drainage was removed and wound dressing was changed until healing. The grade A and grade B healing rate, flap necrosis rate, wound dehiscence rate 2 weeks after operation and healingtime, hospital stay were compared between the two groups. Data were processed with t test and Fisher exact probability test . ResultsTwo weeks after surgery, 8 patients were healed in grade A, 12 patients in grade B, and 4 patients in grade C in the observation group. Three patients were healed in grade A, 11 patients in grade B, and 10 patients in grade C in the control group. The healing rate of grade A and grade B in the observation group was 83.33% (20/24), compared with that in the control group 58.33% (14/24)], there was not statistically significant (P=0.080). Two weeks after surgery, 2 patients had partial necrosis of the distal vein of the flap after blood congestion, and there were 7 patients of their wounds dehiscence when stitches were removed in the observation group. Two weeks after surgery, in the control group, there was partial necrosis of skin flap in 9 patients, while wounds dehiscence in 14 patients when the suture was removed. All of them were healed after dressing change. The rate of postoperative flap necrosis 8.33%(2/24)] and postoperative wound debridement 29.17%(7/24)] in the observation group were superior to those in the control group 37.50%(9/24), 58.33%(14/24)], the differences were statistically significant (P=0.036, 0.005). The length of hospital stay (21.5±3.0) d] and healing time (32.2±3.1) d] in the observation group were significantly shorter than those in the control group(24.3±2.4) d] and (35.7±3.3) d], the differences were statistically significant (t=3.565, 3.719; with P values below 0.01). All 48 patients were followed up for 2-6 months after the operation. All the flaps survived well and no recurrence of pressure injury occurred. ConclusionThe application of preoperative vacuum sealing drainage combined with local rotary flap in the repair of sacrococcygeal pressure injury can significantly improve the clinical efficacy of patients, reduce the length of hospital stay, healing time and postoperative complications.