Disa J J, Carlton J M, Goldberg N H
Department of Surgery, University of Maryland Hospital, Baltimore.
Plast Reconstr Surg. 1992 Feb;89(2):272-8. doi: 10.1097/00006534-199202000-00012.
The advent of air flotation-type beds and purified growth factors that may accelerate open wound contraction, coupled with very high recurrence rates and decreasing health resources, suggests that surgical reconstruction of pressure sores may not be indicated in all patients. In an effort to define which patients might benefit from operation, we reviewed the data from 40 consecutive patients with 68 pressure sores operated on under the direction of a single surgeon between 1981 and 1989. Patients were categorized on the basis of the presence or absence of paraplegia and its etiology. Sixty-six operations were performed, 55 muscle or fasciocutaneous flaps and 11 cutaneous flaps. There was a 36 percent operative complication rate, with no operative mortalities. Follow-up ranged from 1 to 71 months, with a mean of 21 months. Despite an 80% healed rate at the time of discharge, 61% of sores and 69% of patients had recurrent ulceration within a mean of 9.3 months. Analysis of these data indicates that surgical reconstruction of pressure sores does not appear to be efficacious in young posttraumatic paraplegics or cerebrally compromised elderly patients. Further review of the data failed to identify those patients likely to remain healed after operative repair of their pressure sores.
气浮式床和可能加速开放性伤口收缩的纯化生长因子的出现，再加上极高的复发率和日益减少的医疗资源，表明并非所有患者都适合进行压疮的手术重建。为了确定哪些患者可能从手术中获益，我们回顾了1981年至1989年间在一位外科医生指导下接受手术的40例连续患者的68处压疮数据。患者根据是否存在截瘫及其病因进行分类。共进行了66次手术，其中55次采用肌肉或筋膜皮瓣，11次采用皮瓣。手术并发症发生率为36%，无手术死亡病例。随访时间为1至71个月，平均21个月。尽管出院时愈合率达80%，但平均9.3个月内，61%的压疮和69%的患者出现了复发性溃疡。对这些数据的分析表明，压疮的手术重建在年轻的创伤后截瘫患者或脑部受损的老年患者中似乎无效。对数据的进一步审查未能确定哪些患者在压疮手术修复后可能保持愈合状态。
