Haiun M, Feuvrier D, Bayti T, Pluvy I, Pauchot J
Service de chirurgie orthopédique, traumatologique, plastique et reconstructrice, assistance main, CHU J.-Minjoz, 3, boulevard A.-Fleming, 25000 Besançon, France.
Service de chirurgie orthopédique, traumatologique, plastique et reconstructrice, assistance main, CHU J.-Minjoz, 3, boulevard A.-Fleming, 25000 Besançon, France.
Ann Chir Plast Esthet. 2016 Dec;61(6):836-844. doi: 10.1016/j.anplas.2016.08.002. Epub 2016 Sep 7.
Retrospective study about pressure ulcers surgical treatments in a series of 61 in 43 patients.
To assess the management of pressure ulcers in spinal cord injury patients who had been operated in our institution.
On the 61 pressure ulcers, location was ischial in 35 cases, sacral in 15 cases, trochanteric in 7 cases, lateral malleolar in 2 cases, on the heel in 1 case, and 1 was located lateral to the fibular head. Comorbidities were searched pre- and postoperatively. Fifty-five muscular, cutaneous flaps or myocutaneous, 5 fasciocutaneous and 1 excision/suture were realized. The mean follow-up was 8.6 years, and we observed 9 pressure ulcers recurrences (14.8%). We had a total result of 15 (24.6%) complicated pressure ulcers, with 8 early complications (13.1%) and 7 delay (11.5%). Antibiotic therapy was prescribed in 54 (88.5%) surgery cases and 7 were operated without any (11.5%).
Pressure ulcers are major public health focus that need to be improved. A multidisciplinary care, mixed with education of patients are mandatory to achieve these goals: reduce complications and recurrences. Thanks to muscle sparring, perforators flap should become the gold standard of pressure ulcers surgery.
对43例患者的61处压疮手术治疗进行回顾性研究。
评估在我院接受手术治疗的脊髓损伤患者压疮的处理情况。
在61处压疮中,35处位于坐骨,15处位于骶骨,7处位于转子,2处位于外踝,1处位于足跟,1处位于腓骨头外侧。术前和术后均对合并症进行了排查。实施了55例肌皮瓣、肌瓣或肌皮瓣手术,5例筋膜皮瓣手术以及1例切除/缝合手术。平均随访时间为8.6年,观察到9处压疮复发(14.8%)。总共出现了15处(24.6%)复杂压疮,其中8例为早期并发症(13.1%),7例为延迟并发症(11.5%)。54例(88.5%)手术病例使用了抗生素治疗,7例手术未使用任何抗生素(11.5%)。
压疮是需要改善的主要公共卫生重点问题。多学科护理以及对患者的教育对于实现减少并发症和复发这些目标是必不可少的。由于保留了肌肉,穿支皮瓣应成为压疮手术的金标准。