综合法治疗慢性压力性创伤所致压疮的疗效观察

Observation of integrative treatment on the bedsores caused by chronic pressive trauma

目的总结慢性压力性创伤所致压疮的外科治疗经验。方法1997年1月至2008年12月,郴州市第一人民医院烧伤整形科应用皮瓣、游离皮片、术后灌洗及负压吸引等外科方法治疗107例因截瘫、侧瘫、超高龄痴呆等原因导致慢性压力创伤性皮肤、软组织溃烂创面382处。其中尾骶区121处,股骨大转子区96处,坐骨结节63处,髂骨部48处,胸腰椎区22处,足跟部15处,肩胛区17处。围手术期营养不良患者予以营养代谢支持治疗,感染严重者术后持续灌洗与负压吸引,并防止再受压等。结果 382处创面一次性愈合304处,其中158处为肌瓣或肌皮瓣,轴型复合组织瓣76处,游离皮片54处,邻位皮瓣16处。延迟愈合78处,其中轴型复合组织瓣41处,肌皮瓣31处,游离皮片6处。延迟愈合创面修复方法:38处经Ⅱ期扩创后直接缝合治愈,27处经游离皮片移植治愈,13处局部换药治愈(平均17d)。随访6个月时,原位复发压力性创面17例,其中游离植皮占13例。结论改善全身营养,控制局部细菌感染,利用创面周围健康皮肤、肌肉、筋膜形成复合组织瓣修复创面,辅以创底灌洗、负压吸引,避免再受压等是提高慢性压力创伤性创面治愈率和降低复发率的较好方法。

Objective To summarize the methods and results of the surgical treatment of patients with trauma-induced ulcer. Methods From January 1997 to December 2008, 107 cases of paraplegia due to side paralysis, dementia in very old people with chronic stress and other causes of traumatic skin, soft tissue wound fester 382 wounds were treated with flaps, free skin graft, postoperative lavage and suction. The pressure sores were respectively located in sacrococcygeal region （121 wounds）, greater trochanter of femur （96wounds）, ischial tuberosity （63wounds）, iliac region （48wounds）, the thoracic and lumbar area （ 22 wounds）, the heel （ 15 wounds）, the scapular region （17 wounds）. Sisty-nine cases were implemented the irrigation and suction after operation. Perioperative nutrition was used in patients with metabolic support treatment, severe cases of infection after continuous lavage and suction, to prevent further compression. Results Three hundred and four wounds were completely healed among the 382 wounds, 158 wounds were repaired by the muscle flaps or musculocutaneous flaps, 76 wounds by axial composite tissue flap, 54 wounds by transplanting free skin grafts, 16 wounds by suturing directly. Among the 78 wounds heal delayed, axial composite flaps wereused in 41 wounds, flaps in 31 wounds, free skin grafts in 6 wounds. Methods of healing the delayed wounds： 38 wounds were cured by suturing directly after debridementin the second phase , 27 wounds by free skin grafts, 13 wounds by dressing cured （an average of 17 d）. Follow-up over 6 months, 17 cases of wounds were recurren in situ stress, among whom 13 cases were transplanted free skin. Conclusions Improving the general nutrition, controling local bacterial infection,using the healthy skin around the wound, muscle, and the composite tissue flap repairing the wounds, and reinforcing the suction at the end of lavage, to prevent further compression, etc, are good for improving the cure rate and reducing the relapse rate of the chronic stress wounds.