Tchuenkam Landry W, Titcheu Flobert, Mbonda Aimé, Kamto Trevor, Nwaha Axel M, Kamla Igor J, Tochie Joel Noutakdie
Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
Njombe Saint Jean de Malte Hospital, Cameroon.
Int J Surg Case Rep. 2020;73:15-21. doi: 10.1016/j.ijscr.2020.06.060. Epub 2020 Jun 17.
The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative.
We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V-Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter.
PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.
住院患者发生压力性损伤（PI）是一种严重的医疗状况，需要进行严格的临床评估。这些损伤的管理应全面，包括一般措施和局部护理。伤口护理在治疗中占很大一部分。对于大面积皮肤缺损，治疗需要整形外科技术进行重建。肌皮推进皮瓣是一种很好的治疗选择，因为它能在皮肤缺损处提供带血管的组织。为确保手术成功，在与麻醉团队共同仔细准备患者的前提下，良好的手术技术至关重要。
我们报告一例60岁男性病例，该患者在缺血性中风后卧床两个多月，伴有左侧痉挛性偏瘫和感觉丧失。他被转至我们的外科病房，以处理骶尾部慢性4期压力性损伤，并发蜂窝织炎、皮下脓肿和严重脓毒症。初始治疗包括复苏措施，结合液体治疗、抗生素治疗、镇痛、输血、营养支持、物理治疗、伤口护理以及预防措施和心理支持。一旦肉芽组织充分发育，患者接受了V-Y肌皮推进皮瓣重建手术。移植成功，此后伤口完全愈合。
压力性损伤是一种多因素、复杂且致残的病理状况，需要多学科护理。外科医生、麻醉师、营养师、物理治疗师、护士必须协同行动，以提供最佳治疗。预防是关键。
