Firriolo Joseph M, Ganske Ingrid M, Pike Carolyn M, Caillouette Catherine, Faulkner Heather R, Upton Joseph, Labow Brian I
Ann Plast Surg. 2018 Feb;80(2):159-163. doi: 10.1097/SAP.0000000000001226.
Pressure ulcers refractory to nonoperative management may undergo flap reconstruction. This study aims to evaluate the long-term outcomes and recurrence rates of flap reconstruction for pediatric pressure ulcers.
We reviewed the records of patients who underwent flap reconstruction for pressure ulcer(s) from 1995 to 2013.
Twenty-four patients with 30 pressure ulcers, requiring 52 flaps were included. Ulcers were stages III and IV and mostly involved either the ischia (15/30) or sacrum (8/30). Flaps were followed for a median of 4.9 years. Twenty-three patients were wheelchair dependent, and 20 had sensory impairment at their ulcer site(s). Ten patients had a history of noncompliance with preoperative management, 8 of whom experienced ulcer recurrence. Twenty-one ulcers had underlying osteomyelitis, associated with increased admissions (P = 0.019) and cumulative length of stay (P = 0.031). Overall, there was a 42% recurrence rate in ulceration after flap reconstruction. Recurrence was associated with a preoperative history of noncompliance with nonoperative therapy (P = 0.030), but not with flap type or location, age, sex, body mass index, osteomyelitis, or urinary/fecal incontinence (P > 0.05, all).
Flap reconstruction can be beneficial in the management of pediatric pressure ulcers. Although high rates of long-term success with this intervention have been reported in children, we found rates of ulcer recurrence similar to that seen in adults. Poor compliance with nonoperative care and failure to modify the biopsychosocial perpetuators of pressure ulcers will likely eventuate in postoperative recurrence. Despite the many comorbidities observed in our patient sample, compliance was the best indicator of long-term skin integrity and flap success.
非手术治疗无效的压疮可能需要进行皮瓣重建。本研究旨在评估小儿压疮皮瓣重建的长期疗效和复发率。
我们回顾了1995年至2013年因压疮接受皮瓣重建的患者记录。
纳入24例患者的30处压疮，共需要52块皮瓣。压疮为Ⅲ期和Ⅳ期，主要累及坐骨（15/30）或骶骨（8/30）。皮瓣随访时间中位数为4.9年。23例患者依赖轮椅，20例在溃疡部位存在感觉障碍。10例患者有术前不依从治疗史，其中8例发生溃疡复发。21处溃疡合并骨髓炎，与住院次数增加（P = 0.019）和累计住院时间延长（P = 0.031）相关。总体而言，皮瓣重建后溃疡复发率为42%。复发与术前不依从非手术治疗史有关（P = 0.030），但与皮瓣类型或位置、年龄、性别、体重指数、骨髓炎或尿/粪失禁无关（P均> 0.05）。
皮瓣重建对小儿压疮的治疗可能有益。尽管已有报道称该干预措施在儿童中具有较高的长期成功率，但我们发现溃疡复发率与成人相似。非手术护理依从性差以及未能改变压疮的生物心理社会促发因素可能会导致术后复发。尽管在我们的患者样本中观察到许多合并症，但依从性是长期皮肤完整性和皮瓣成功的最佳指标。
