Foster R D, Anthony J P, Mathes S J, Hoffman W Y, Young D, Eshima I
Division of Plastic and Reconstructive Surgery, University of California at San Francisco, USA.
Arch Surg. 1997 Aug;132(8):868-73. doi: 10.1001/archsurg.1997.01430320070011.
To establish a treatment algorithm for the long-term surgical management of pressure sores.
Retrospective case series.
University-based teaching hospital.
From March 1979 to July 1995, 280 unselected pressure sore reconstructions (113 ischial, 94 sacral, and 73 trochanteric sores) were performed in 201 patients (130 men and 71 women; age range, 16-90 years; mean, 50 years). Of the patients, 90% had severe spinal cord injuries (paraplegia or quadriplegia). Forty-one percent of the wounds were chronic (present longer than 3 months).
Length of stay, postoperative morbidity and mortality, and flap success (defined as a completely healed wound).
Overall, 89% of the flaps healed primarily (ischium, 83% [94/113]; sacrum, 91% [86/94]; trochanter, 93% [68/73]). Three fourths of cases were treated in a single stage (debridement and reconstruction). The inferior gluteus maximus island flap (ischium) (94% [32/ 34]), the V-Y gluteus maximus advancement flap (sacrum) (97% [36/37]), and the tensor fascia lata flap (trochanter) (95% [42/44]) had the highest success rates. Flap success was not significantly affected by the size of the pressure sore or the number of previous flaps used. Postoperative hospital stays averaged 20 days. The overall complication rate was 28%, most commonly from a slight wound edge dehiscence.
Flap selection and the appropriate short- and long-term sequence of flap use significantly improve success rates for pressure sore coverage. Reconstruction can be reliably performed in a single stage with a relatively short hospitalization.
建立一种用于压疮长期外科治疗的算法。
回顾性病例系列研究。
大学附属医院。
1979年3月至1995年7月，对201例患者（130例男性，71例女性；年龄范围16 - 90岁，平均50岁）进行了280例未经选择的压疮修复手术（113例坐骨部、94例骶尾部和73例转子部压疮）。其中90%的患者患有严重脊髓损伤（截瘫或四肢瘫）。41%的伤口为慢性伤口（存在超过3个月）。
住院时间、术后发病率和死亡率以及皮瓣成功率（定义为伤口完全愈合）。
总体而言，89%的皮瓣一期愈合（坐骨部，83%[94/113]；骶尾部，91%[86/94]；转子部，93%[68/73]）。四分之三的病例采用一期治疗（清创和重建）。臀大肌下岛状皮瓣（坐骨部）（94%[32/34]）、V - Y推进臀大肌皮瓣（骶尾部）（97%[36/37]）和阔筋膜张肌皮瓣（转子部）（95%[42/44]）成功率最高。压疮大小或既往使用皮瓣的数量对皮瓣成功率无显著影响。术后平均住院时间为20天。总体并发症发生率为28%，最常见的是伤口边缘轻度裂开。
皮瓣选择以及皮瓣使用的适当短期和长期顺序可显著提高压疮覆盖的成功率。重建手术可在一期可靠完成，住院时间相对较短。
