Flap selection as a determinant of success in pressure sore coverage.
Flap selection as a determinant of success in pressure sore coverage.
复制标题
皮瓣选择是压疮覆盖成功的决定因素。
DOI：
10.1001/archsurg.1997.01430320070011
复制
发表时间：
1997
影响因子：
--
通讯作者：
I. Eshima
中科院分区：
文献类型：
--
作者：
R. Foster;J. Anthony;S. Mathes;W. Hoffman;David J. Young;I. Eshima
客观化
建立长期手术治疗压疮的治疗算法。
设计
回顾病例系列。
设置
以大学为基础的教学医院。
病人
自1979年3月至1995年7月，对201例(男130例，女71例；年龄16~90岁，平均50岁)施行了280例非选择性压疮重建术。在这些患者中，90%有严重的脊髓损伤(截瘫或四肢瘫痪)。41%的伤口是慢性的(出现时间超过3个月)。
主要结果衡量标准
住院时间，术后发病率和死亡率，以及皮瓣成功(定义为完全愈合的伤口)。
结果
总体而言，89%的皮瓣一期愈合(坐骨83%[94/113]；骶骨91%[86/94]；大转子93%[68/73])。四分之三的病例在单一阶段(清创和重建)得到治疗。其中臀大肌岛状瓣(坐骨)(94%)、臀大肌V-Y推进瓣(骶骨)(97%[36/37])、阔筋膜张肌(粗隆)瓣(95%[42/44])成功率最高。压疮的大小或以前使用的皮瓣数量对皮瓣成功率没有显著影响。术后平均住院天数为20天。总的并发症发生率为28%，最常见的原因是轻微的伤口边缘裂开。
结论
皮片的选择和适当的短期和长期皮片使用顺序显著提高了压疮覆盖的成功率。重建可以在相对较短的住院时间内可靠地在单个阶段进行。
OBJECTIVE
To establish a treatment algorithm for the long-term surgical management of pressure sores.
DESIGN
Retrospective case series.
SETTING
University-based teaching hospital.
PATIENTS
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).
MAIN OUTCOME MEASURES
Length of stay, postoperative morbidity and mortality, and flap success (defined as a completely healed wound).
RESULTS
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.
CONCLUSIONS
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.