VSD联合局部改良菱形皮瓣修复骶尾部深度压疮的临床效果观察

Clinical Observation of VSD Combined with Modified Rhomboid Flap in Repairing Sacrococcygeal Deep Decubitus

目的 分析负压封闭引流(VSD)联合改良菱形皮瓣修复骶尾部深度压疮的临床疗效。方法 回顾分析我院烧伤整形科2017年9月—2020年9月收治的骶尾部深度压疮48例,依据患者创面及全身情况进行治疗。26例(联合治疗组)按照损伤控制外科(DCS)理念,一期清创后使用VSD暂时封闭创面,二期设计局部菱形皮瓣修复创面;22例(单一治疗组)创面良好,仅行一期皮瓣转移修复术。观察2组住院时间、术前VSD时间及手术时间,以及术后并发症发生情况和预后。结果 48例中46例术后创面一期愈合,成功率为95.8%。联合治疗组住院时间长于对照组,手术时间短于对照组(P<0.05)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。48例术后随访6~12个月,皮瓣外观及弹性良好,耐磨耐压,未发生破溃。结论 VSD联合局部改良菱形皮瓣修复骶尾部深度压疮操作简单,创伤小,有效缩短了手术时间,并不增加术后并发症的发生,符合DCS理念,具有独特的优势。

Objective To explore the clinical effect of vacuum sealing drainage(VSD) combined with modified rhomboid flap in the treatment of sacrococcygeal deep decubitus. Methods A retrospective analysis was performed on 48 patients with sacrococcygeal deep decubitus admitted to the Department of Burn and Plastic Surgery in our hospital from September 2017 to September 2020. The patients were treated according to their wound and general condition. According to the concept of damage control surgery(DCS),the wound of 26 patients(combination treatment group) was closed temporarily with VSD after primary debridement, and the local rhomboid flap was designed for the second-stage repair of the wound. In addition, 22 patients(single treatment group) had good wounds and only received one-stage flap transfer for repairing wounds. The length of hospitalization, preoperative VSD time, duration of operation, and postoperative complications and prognosis were observed between the two groups. Results Of the 48 cases, 46 had primary healing of the postoperative wounds, and the success rate was 95.8%. The length of hospitalization in the combination treatment group was longer than that in the control group, while the duration of operation was shorter than that in the control group(P<0.05). There was no statistical significance in the total incidence of postoperative complications between the two groups(P>0.05). All 48 patients were followed up for 6-12 months. The skin flap had good appearance and elasticity, which had high resistance and pressure resistance, and no rupture occurred. Conclusion VSD combined with locally modified rhomboid flap in the treatment of sacrococcygeal deep decubitus has the characteristics of simple operation and small trauma, which effectively reduces the duration of operation, does not increase the occurrence of postoperative complications, conforms to the concept of DCS, and has unique advantages.