负压封闭引流结合臀大肌肌皮瓣在骶尾部褥疮修复中的应用

目的]探讨负压封闭引流(VSD)结合臀大肌肌皮瓣修复骶尾部褥疮的临床效果.方法]选择2005年2月～2009年2月收治的骶尾部褥疮患者31例,男17例,女14例；年龄30～ 75岁,病程0.2 ～20年.创面面积:5cm×6.5cm～8cm×12.5cm.随机分为两组:治疗组16例,创面先经负压封闭引流处理,设计以臀上动脉浅支为血管蒂的臀大肌上部肌皮瓣,修复骶尾部褥疮.对照组15例,常规换药处理后臀大肌上部肌皮瓣修复.结果] 29例患者皮瓣一期存活,试验组和对照组各有1例皮瓣远端部分坏死,经换药后愈合.治疗过程中无大出血、血管神经损伤、感染等并发症.所有患者均获随访,随访时间12 ～18个月,肌皮瓣质地良好,褥疮无复发,功能满意.试验组在换药次数、住院时间及抗生素使用等方面优于对照组,差异有统计学意义(P＜0.01).结论]应用负压封闭引流结合臀大肌肌皮瓣修复骶尾部褥疮,能够明显缩短病程,并发症少,成功率高,是治疗骶尾部褥疮的理想方法之一.

Clinical application of vacuum sealing drainage and gluteus maximus myocutaneous flaps transfering for the repairing of sacral pressure sores

Objective]To explore the clinical effects of vacuum sealing drainage and gluteus maximus myocutaneous flaps transfering for the repair of sacral pressure sores.Methods]From February 2005 to February 2009,31 pressure sores paients,17 males and 14 females aged 30-75 years,were treated.The course of disease was from 0.2 to 20 years.The size of wound ranged from 5 cm×6.5 cm to 8 cm×12.5 cm.The patieuts were randomly divided into testing group and control group.Sixteen were treated by gluteus maximus myocutaneous flaps with gluteus upper artery after vacuum sealing drainage as the testing group and 15 were repaired by gluteus maximus myocutaneous flaps after routine dressing change as the control group.Results]The flaps survived by first intention in 29 patients.Parital necrosis in one of each group healed after dressing change.During the treatment,there were no complications of hemorrhage,injuries of vessels and nerves,and infection.All paients were followed up for 12~18 months.Quality and shape of all the flaps and functional recovery were satisfactory with no recurrence of sores.Dressing changes,hospital stay and antibiotics cost for the testing group were superior to those for the control group,and the difference had statistical significance(P<0.01).Conclusion]Vacuum sealing drainage and gluteus maximus myocutaneous flaps transfering for sacral pressure sores is an ideal methed.It has ideal way with shorter hospital stay,few complication and high survival rate to repair.