Greco Manfredi, Marchetti Francesco, Tempesta Massimo, Ruggiero Marco, Marcasciano Marco, Carlesimo Bruno
Ann Ital Chir. 2013 Nov-Dec;84(6):655-9.
Muscular flaps are considered by many surgeons as a treatment of choice for pressure sores. Nevertheless fasciocutaneous and adipofascial flaps are less sensitive to ischemia, more resistant to pressure and have higher mechanical resistance. The aim of this study is to evaluate the results of our integrated rehabilitative and surgical protocol in pressure sore management based on the use of cutaneous flaps.
Since 1998, we treated 338 pressure sores (PS) in 195 patients (120 males; 75 females), 189 patients were affected by paraplegia and tetraplegia and 6 of them by neurological disorders.
Ninety sacral, 156 ischiatic, 75 trochanteric, 9 calcanean and 8 sores of the iliac-crest were succesfully treated. All showed an involvement of the bone element, with osteitis and/or periosteitis. 14 cases of trocanteric sores showed a deeper bone involvement, with evidences of osteomyelitis. Follow up ranges from 7 years to 2 months. Median time for wound healing was 18 days.
The use of fasciocutaneous flaps, as an alternative to the traditional muscolocutaneous flaps in the treatment of pressure sores leads to good and statistically comparable, healing rate, time and incidence of complications. Reconstructive plastic surgery as is a decisive factor to reach a good rehabilitative outcome, minimizing the time of rehabilitation with a following decrease of hospitalization costs. In spinal cord injured patients, surgical treatment of pressure sores is not proposed as the main procedure, but it is an important stage during the natural history of pressure sores.
Cutaneous, adipofascial and fasciocutaneous flaps are less invasive, of a relatively easy execution, provided by a reliable vascular pedicle and they could be "re-used" in case of recurrences.
许多外科医生认为肌皮瓣是治疗压疮的首选方法。然而，筋膜皮瓣和脂肪筋膜皮瓣对缺血不太敏感，对压力更具抵抗力，并且具有更高的机械阻力。本研究的目的是评估我们基于使用皮瓣的综合康复和手术方案在压疮管理中的效果。
自1998年以来，我们治疗了195例患者（120例男性；75例女性）的338处压疮，其中189例患者患有截瘫和四肢瘫，6例患有神经系统疾病。
90处骶部、156处坐骨部、75处转子部、9处跟骨部和8处髂嵴部压疮得到成功治疗。所有病例均显示骨组织受累，伴有骨炎和/或骨膜炎。14例转子部压疮显示骨组织受累更深，有骨髓炎的迹象。随访时间从7年到2个月不等。伤口愈合的中位时间为18天。
在压疮治疗中，使用筋膜皮瓣替代传统的肌皮瓣可获得良好的、统计学上可比的愈合率、愈合时间和并发症发生率。整形重建手术是实现良好康复效果的决定性因素，可将康复时间减至最短，进而降低住院费用。在脊髓损伤患者中，压疮的手术治疗并非主要治疗手段，但它是压疮自然病程中的一个重要阶段。
皮肤瓣、脂肪筋膜瓣和筋膜皮瓣侵入性较小，操作相对简单，有可靠的血管蒂，并且在复发时可以 “再次使用”。
