Chiu Yu-Jen, Liao Wen-Chieh, Wang Tien-Hsiang, Shih Yu-Chung, Ma Hsu, Lin Chih-Hsun, Wu Szu-Hsien, Perng Cherng-Kang
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1038-1043. doi: 10.1016/j.bjps.2017.04.004. Epub 2017 Apr 23.
Despite significant advances in medical care and surgical techniques, pressure sore reconstruction is still prone to elevated rates of complication and recurrence. We conducted a retrospective study to investigate not only complication and recurrence rates following pressure sore reconstruction but also preoperative risk stratification.
This study included 181 ulcers underwent flap operations between January 2002 and December 2013 were included in the study. We performed a multivariable logistic regression model, which offers a regression-based method accounting for the within-patient correlation of the success or failure of each flap.
The overall complication and recurrence rates for all flaps were 46.4% and 16.0%, respectively, with a mean follow-up period of 55.4 ± 38.0 months. No statistically significant differences of complication and recurrence rates were observed among three different reconstruction methods. In subsequent analysis, albumin ≤3.0 g/dl and paraplegia were significantly associated with higher postoperative complication. The anatomic factor, ischial wound location, significantly trended toward the development of ulcer recurrence. In the fasciocutaneous group, paraplegia had significant correlation to higher complication and recurrence rates. In the musculocutaneous flap group, variables had no significant correlation to complication and recurrence rates. In the free-style perforator group, ischial wound location and malnourished status correlated with significantly higher complication rates; ischial wound location also correlated with significantly higher recurrence rate.
Ultimately, our review of a noteworthy cohort with lengthy follow-up helped identify and confirm certain risk factors that can facilitate a more informed and thoughtful pre- and postoperative decision-making process for patients with pressure ulcers.
尽管医疗护理和手术技术取得了显著进展，但压疮重建术后仍容易出现较高的并发症发生率和复发率。我们进行了一项回顾性研究，不仅调查压疮重建术后的并发症和复发率，还对术前风险进行分层。
本研究纳入了2002年1月至2013年12月期间接受皮瓣手术的181例溃疡患者。我们构建了一个多变量逻辑回归模型，该模型提供了一种基于回归的方法，用于考虑每个皮瓣成功或失败的患者内相关性。
所有皮瓣的总体并发症发生率和复发率分别为46.4%和16.0%，平均随访期为55.4±38.0个月。三种不同重建方法的并发症和复发率在统计学上无显著差异。在后续分析中，白蛋白≤3.0 g/dl和截瘫与术后较高的并发症显著相关。解剖学因素，即坐骨伤口位置，显著倾向于溃疡复发的发生。在筋膜皮瓣组中，截瘫与较高的并发症和复发率显著相关。在肌皮瓣组中，各变量与并发症和复发率无显著相关性。在游离穿支皮瓣组中，坐骨伤口位置和营养不良状态与显著较高的并发症发生率相关；坐骨伤口位置也与显著较高的复发率相关。
最终，我们对一个进行了长期随访的重要队列的回顾，有助于识别和确认某些风险因素，从而为压疮患者在术前和术后做出更明智、更周全的决策提供便利。
