Lüscher N J
Klinik für wiederherstellende Chirurgie der Universität, Kantonsspital Basel.
Ther Umsch. 1991 May;48(5):341-6.
Geriatric patients have a high incidence of pressure sores. Pain, chronic and acute infection and protein loss may impair their general condition. Pressure relief, local débridement, disinfection and physiologic wound dressing are the first steps in local treatment. The spontaneous healing time of a pressure sore is very slow, even if concomitant diseases as diabetes, urinary tract infection and pneumonia could be stabilized and the general condition of the patient be improved. In these selected and stable cases, surgical débridement and plastic pressure sore closure may be indicated. Simple skinflaps can give good results in superficial sores without bone involvement and have a low operative morbidity. Musculocutaneous flaps are technically more difficult, but resist better to infection and may fill bigger and deeper defects. In any operation, vascular territories (angiosomes) of further flaps, suitable for a recurrent or second decubitus closure, must be preserved. Long-term results in 30 operated patients over 60 are presented. Although the postoperative complication rate is very high, healing could be achieved in all surviving patients.
老年患者压疮发生率较高。疼痛、急慢性感染及蛋白质丢失可能会损害他们的总体状况。减压、局部清创、消毒及生理性伤口敷料是局部治疗的首要步骤。即使糖尿病、尿路感染及肺炎等伴随疾病能够得到控制且患者总体状况有所改善，压疮的自然愈合时间仍然非常缓慢。在这些经过挑选且病情稳定的病例中，可能需要进行手术清创及整形修复压疮。对于未累及骨骼的浅表性压疮，简单的皮瓣转移可取得良好效果，且手术并发症发生率较低。肌皮瓣技术上难度更大，但抗感染能力更强，可填充更大、更深的缺损。在任何手术中，必须保留适合再次修复或二次褥疮闭合的额外皮瓣的血管区域（血管体）。本文介绍了60岁以上30例接受手术患者的长期结果。尽管术后并发症发生率很高，但所有存活患者均实现了愈合。
