负压封闭引流联合臀上动脉穿支皮瓣修复骶尾部压疮

Effect of Vacuum Sealing Drainage Combined with Superior Gluteal Artery Perforator Flap in Repairing Sacrococcygeal Pressure Ulcers

目的:探讨负压封闭引流(Vacuum sealing drainage,VSD)联合臀上动脉穿支皮瓣修复骶尾部压疮的应用价值。方法:回顾性分析2017年1月-2019年8月笔者医院收治的80例骶尾部压疮患者的临床资料,按治疗方法不同分为对照组39例,观察组41例。对照组实施臀上动脉穿支皮瓣修复术,观察组在对照组的基础上联用VSD。对比两组创面愈合效果、皮瓣存活率、创面一期愈合率、感染发生率、术前抗生素使用时间、创面愈合时间以及住院时间;并随访12个月,记录复发率。结果:观察组创面愈合优良率高于对照组(97.56%vs 82.05%),差异有统计学意义(P<0.05)。观察组皮瓣完全存活率、创面一期愈合率分别为100.00%、95.12%,高于对照组的89.74%、76.92%,且观察组感染发生率为7.32%,低于对照组的25.64%,差异均有统计学意义(P<0.05)。观察组术前抗生素使用时间、创面愈合时间、住院时间均明显短于对照组,差异有统计学意义(P<0.05)。随访12个月,观察组复发率为2.44%,低于对照组的15.38%,差异有统计学意义(P<0.05)。结论:VSD联合臀上动脉穿支皮瓣修复骶尾部压疮治疗效果显著,可有效提高皮瓣存活率和创面愈合效果,并能控制感染,促进创面愈合,同时能降低复发率。

Objective To explore the application value of vacuum sealing drainage(VSD)combined with superior gluteal artery perforator flap in repairing sacrococcygeal pressure ulcers.Methods Retrospective analysis was made on the clinical data of 80 patients with sacrococcygeal pressure ulcers admitted by the author’s hospital from January 2017 to August 2019.According to different treatment methods,39 cases were divided into the control group and 41 cases into the observation group.The control group performed superior gluteal artery perforator flap repair,and the observation group was combined with VSD on the basis of the control group.The wound healing effect,flap survival rate,first-stage wound healing rate,infection occurrence,preoperative antibiotic use time,wound healing time and hospital stay were compared between the two groups.The recurrence rate was recorded after 12 months follow-up.Results The good rate of wound healing in the observation group was higher than that in the control group(97.56%vs 82.05%),the difference was statistically significant(P<0.05).The complete survival rate of the skin flap and the first-stage wound healing rate of the observation group were 100.00%and 95.12%,respectively,which were higher than those of the control group(89.74%,76.92%,P<0.05).The incidence of infection in the observation group was 7.32%,which was lower than that of the control group(25.64%,P<0.05).The preoperative antibiotic use time,wound healing time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05).After 12 months of follow-up,the recurrence rate in the observation group was 2.44%,which was lower than that in the control group(15.38%,P<0.05).Conclusion In patients with sacrococcygeal pressure ulcers,the VSD combined with superior gluteal artery perforator flap repair has a significant therapeutic effect,which can effectively improve the survival rate of the flap and the wound healing effect,control infection,promote wound healing,and reduce the recurrence rate.