Zogovska E, Novevski L, Agai Lj, Mircevski V, Peev I, Dzokic Gj
Plastic and Reconstructive Surgery Clinic, Skopje, R. Macedonia.
Prilozi. 2008 Jul;29(1):199-210.
Pressure ulcers appear in very ill patients and in states of prolonged immobilization. They are quite frequent in intensive care units and in paraplegic individuals. The expenses for their sanation are huge, due to the complicity of the long-lasting treatment. Shallow and superficial pressure ulcers are treated conservatively. Deep ones, with expressive underlying bone prominence in which no regression is on-going, are better to be treated operatively, if possible. Thus the hospitalisation period and the need for frequent dressings are shortened, preventing enormous scars (sanatio per secundam intentionem of the wound) and the risk of subsequent infection. What is also important for the treatment of the prime disease is that the patient can rehabilitate earlier. There are many methods of excision of the ulcer, ablation of the bone prominence and coverage of the defect with different types of flaps afterwards. Although muscle flaps can be utilized, we assume that their use additionally influences the general condition of the patient (malnutrition and anaemia always co-exist). Thus we find our way of treatment less traumatising and better, if pliable, for decubital ulcers. The objective of the study was to evaluate the clinical results after an operative treatment of deep decubital ulcers (III and IV grade) with local dermal flaps and to promote the method of their closure. We paid special attention to ablation of the bone prominence. We used local pivotal adipose-cutaneous flaps in order to cover the cleansed tissue defect. The types of flaps employed were unilateral and bilateral rotation flaps, transposition and bipedicular flaps. Our series covered 23 patients who were operated on in the last 10 years, of whom 16 (69.6%) had a spinal cord injury (paraplegic). Pressure ulcers in the sacral region dominated with 12 cases (52.2%). The operative techniques that we used were as follows: unilateral rotation flaps (in 7 patients), bilateral rotation flap (in 1 patient), transposition flaps (in 10 patients), bipedicular flaps (in 2 patients), free skin Thiersch auto-transplant (in 2 patients) and direct closure of the defect (in 1 patient). The results advocate the justification of these ways of treatment of pressure ulcers, with few early and late complications.
压疮出现在重症患者以及长期制动的情况下。在重症监护病房和截瘫患者中相当常见。由于长期治疗的复杂性，其治疗费用高昂。浅表性压疮采用保守治疗。对于深部压疮，若存在明显的深部骨隆突且无好转趋势，若有可能，最好进行手术治疗。这样可缩短住院时间和减少频繁换药的需求，防止形成巨大瘢痕（伤口二期愈合）以及后续感染的风险。对于原发病的治疗同样重要的是患者能够更早康复。溃疡切除、骨隆突切除以及随后用不同类型皮瓣覆盖缺损有多种方法。虽然可使用肌皮瓣，但我们认为其使用会额外影响患者的一般状况（营养不良和贫血常并存）。因此，我们发现我们的治疗方法对褥疮的创伤较小，且如果可行的话，效果更好。本研究的目的是评估采用局部皮瓣手术治疗深部褥疮（III级和IV级）后的临床效果，并推广其闭合方法。我们特别关注骨隆突的切除。我们使用局部枢轴脂肪皮瓣来覆盖清洁后的组织缺损。所用皮瓣类型为单侧和双侧旋转皮瓣、移位皮瓣和双蒂皮瓣。我们的系列研究涵盖了过去10年接受手术的23例患者，其中16例（69.6%）患有脊髓损伤（截瘫）。骶尾部压疮占主导，有12例（52.2%）。我们使用的手术技术如下：单侧旋转皮瓣（7例患者）、双侧旋转皮瓣（1例患者）、移位皮瓣（10例患者）、双蒂皮瓣（2例患者）、游离皮肤蒂尔施自体移植（2例患者）以及直接闭合缺损（1例患者）。结果表明这些治疗压疮的方法是合理的，早期和晚期并发症较少。
