Operative debridement of pressure ulcers.
Operative debridement of pressure ulcers.
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DOI：
10.1007/s00268-009-0024-4
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发表时间：
2009-07
影响因子：
2.6
通讯作者：
Brem, Harold
中科院分区：
文献类型：
--
作者：
Schiffman, Jessica;Golinko, Michael S.;Yan, Alan;Flattau, Anna;Tomic-Canic, Marjana;Brem, Harold
严重压疮的感染可导致败血症，6个月死亡率高达68%。从创伤电子病历中回顾了60名创面愈合专科住院患者142例连续清创的手术记录，以确定清创技术的关键步骤、死亡率、意外回流以及清创后出院的时间。患者的平均年龄为73.1岁，其中45%是男性。大多数伤口(53%)位于髋部(坐骨或粗隆)，其他(32%)位于骶骨和脚后跟(14%)。清创前的平均初始创面面积为14.0平方厘米，83%的清创是在IV期压疮时进行的。术后平均住院天数为4.1天。该技术的关键步骤包括：(1)通过切除覆盖组织暴露破坏区域；(2)从伤口边缘移除骨痂；(3)移除所有严重感染的组织；(4)清创所有无活性或受感染的组织后，获取深层组织的活检，以进行培养和病理检查，以确定是否存在感染、纤维化和肉芽组织。清创术后9天有1例死亡，清创8天后因出血意外返回手术室1例。手术清除压疮是安全的，尽管严重压疮的患者存在内科并发症。适当的清创技术可以预防合并多种疾病患者的脓毒症和死亡。
Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%. Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement. The mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm2, and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement. Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions.
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影响因子：
2.9
作者：
De Vries, Henry J. C.;Mekkes, Jan R.;Westerhof, Wiete
通讯作者：
Westerhof, Wiete
影响因子：
3
作者：
Brem, Harold;Lyder, Courtney
通讯作者：
Lyder, Courtney
DOI：
10.1093/gerona/61.7.749
发表时间：
2006-07-01
影响因子：
5.1
作者：
Baumgarten, Mona;Margolis, David J.;Ruffin, Althea
通讯作者：
Ruffin, Althea
影响因子：
1.5
作者：
Kuwahara, M;Tada, H;Yasuda, Y
通讯作者：
Yasuda, Y
影响因子：
5.7
作者：
Brem, Harold;Stojadinovic, Olivera;Tomic-Canic, Marjana
通讯作者：
Tomic-Canic, Marjana