负压创面治疗技术联合皮瓣分期修复臀股部多发Ⅳ期压疮

Application of Negative Pressure Wound Therapy Combined with Skin Flap in Staged Repair of Multiple GradeⅣPressure Ulcers in Buttock and Thigh

目的:总结应用负压创面治疗技术(Negative pressure wound therapy,NPWT)联合皮瓣分期修复臀股部多发Ⅳ期压疮的临床治疗经验。方法:2010年1月-2019年6月,对35例患者分布于骶尾部、坐骨结节区、股骨粗隆区的压疮创面共82处,在应用NPWT基础上,依据创面深度、部位及手术时机不同,采用任意皮瓣、带蒂筋膜瓣或岛状肌皮瓣进行分期手术修复。结果:35例患者术后皮瓣全部成活。平均住院时间(28.3±7.8)d;平均术中失血量(220.3±50.8)毫升/次;平均手术时长(2.0±0.4)h。术后随访0.5~2年,其中32例患者未出现复发,2例患者在其他部位出现压疮,1例坐骨结节区压疮患者原位复发。结论:NPWT联合多种皮瓣分期修复多发压疮创面,使手术方式简化,单次手术时间缩短,手术创伤减小,保障了较高的手术成功率,增加了患者的手术耐受性及治疗信心。

Objective To summarize the experience of negative pressure wound therapy(NPWT)combined with skin flap in staged repair of multiple gradeⅣpressure ulcers in buttock and thigh.Methods From January 2010 to June 2019,a total of 82 pressure sore wounds in 35 patients were located in the sacral,ischium tuberosity and femoral trochanter.Based on the application of NPWT and depending on the depth,location and surgical timing of the wounds,random flap,pedicled fascial flap or island myocutaneous flap were used for surgical repair by stages.Results All the flap of 35 patients survived.The average length of stay was(28.3±7.8)d.The average intraoperative blood loss was(220.3±50.8)ml/time and the average operation time was(2.0±0.4)h.In the postoperative follow-up of 0.5-2 years,32 patients had no recurrence,2 patients had pressure ulcers at other sites,and one patient had in-situ recurrence of pressure ulcers at the ischial nodule area.Conclusion NPWT combined with multiple skin flaps was used to repair multiple pressure ulcer wounds by stages,which simplified the operation method,shortened the time of a single operation and reduced the surgical trauma,ensured a higher surgical success rate,and increased the patient's surgical tolerance and treatment confidence.