Fujioka Masaki, Hayashida Kenji, Morooka Sin, Saijo Hiroto
Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan; email:
Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
Ostomy Wound Manage. 2014 Apr;60(4):42-8.
Wound coverage using a flap, most commonly a perforator or rotation flap, often is required for the closure of extensive sacral pressure ulcers. To assess the duration of wound healing and postsurgical complications following two types of surgical closure procedure, perforator and rotation flaps, a retrospective study was conducted among a convenience sample of 20 patients (10 men, 10 women) with Stage IV sacral pressure ulcers. All ulcers were repaired in 2011 and 2012 by the same surgical group and included nine perforator and 11 rotation flaps. Patient demographic and wound outcomes data were abstracted, and data were analyzed using Wilcoxon signed rank and chi-squared tests. No significant differences were noted in patient demographics between the two groups, although serum albumin level in the rotation flap group was significantly higher than in the perforator flap group (P = 0.01). The mean follow-up period was 18 (range 6-30) months. Mean time to healing was 34 ± 15.4 (range 10-58) days in patients with a perforator flap and 45.5 ± 24.0 (range 11-80) days in patients with a rotation flap (P = 0.03). Patients who underwent rotation flap surgery had a higher rate of postoperative complications and a significantly higher rate of postsurgical seroma (n = 9) compared to those who underwent perforator flap surgery (n= 2) (P = 0.05). The mean time to healing in both groups was 13.5 days in patients without and 48.5 days in patients who developed a seroma. (P <0.01). The results of this study show the proportion of patients who develop a seroma following surgical repair of a sacral pressure is lower following perforator than rotation flap surgery. Additional clinical studies are needed to confirm these findings.
对于广泛的骶骨压疮的闭合，通常需要使用皮瓣进行伤口覆盖，最常用的是穿支皮瓣或旋转皮瓣。为了评估两种手术闭合方法（穿支皮瓣和旋转皮瓣）后的伤口愈合时间和术后并发症，对20例（10例男性，10例女性）IV期骶骨压疮患者的便利样本进行了一项回顾性研究。所有溃疡均在2011年和2012年由同一手术团队修复，包括9例穿支皮瓣和11例旋转皮瓣。提取了患者的人口统计学和伤口结局数据，并使用Wilcoxon符号秩检验和卡方检验进行数据分析。两组患者的人口统计学特征无显著差异，尽管旋转皮瓣组的血清白蛋白水平显著高于穿支皮瓣组（P = 0.01）。平均随访期为18（范围6 - 30）个月。穿支皮瓣患者的平均愈合时间为34±15.4（范围10 - 58）天，旋转皮瓣患者为45.5±24.0（范围11 - 80）天（P = 0.03）。与接受穿支皮瓣手术的患者（n = 2）相比，接受旋转皮瓣手术的患者术后并发症发生率更高，术后血清肿发生率显著更高（n = 9）（P = 0.05）。两组中无血清肿患者的平均愈合时间为13.5天，发生血清肿患者为48.5天。（P <0.01）。本研究结果表明，骶骨压疮手术修复后发生血清肿的患者比例，穿支皮瓣手术低于旋转皮瓣手术。需要更多的临床研究来证实这些发现。
