Combined treatment of patients with stage Ⅳ pressure sores
ZHANG Xiaoqi1, LUAN Tao2, HOU Yushan1, TAN Yifu1, GONG Chenwei3
1. The First Department of General Surgery, 2. The Third Department of General Surgery, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Force, Shenyang 110034, China, 3. Department of Psychology, Hospital of Beijing Armed Police Corps, Beijing, 100020, China
Abstract：Objective To explore the treatments and therapeutic effect of stage Ⅳ pressure ulcer. Methods Between January 2015 and December 2018, 23 patients with 34 stage Ⅳ pressure sores were admitted to the First Department of General Surgery of Liaoning Provincial Corps Hospital of Chinese People's Armed Police Force, including 17 males and 6 females, aged 48 to 78. The wounds were located in the sacrococcygeal region in 15 cases, in the greater trochanter of the femur in 10 cases, in the ischial tuberosity in 6 cases, and in the ankle in 3 cases. The wounds ranged from 4 cm× 5 cm to 7 cm×12 cm in size. The patients underwent combined treatment, including systemic treatment, wound bed preparation, flaps or myocutaneous flaps, and postoperative management. Six wounds were repaired by local flaps, 8 by gluteus maximus myocutaneous flaps, 10 by tensor fascia lata island myocutaneous flaps, 5 by superior gluteal artery perforator island flaps, 3 by peroneal artery perforator flaps, and 2 by neurocutaneous femoris posterior flaps. Results The general nutritional status of these patients was improved. Blood pressure and blood glucose were under effective control. Granulation tissue turned fresh, necrosis tissue was removed, secretion reduced and no redness or swelling occurred in wounds. All the flaps survived. The sutures of flaps were removed in 12 to 14 days postoperatively and the wounds healed. Hospital stay ranged from 22 to 36 days and averaged 29 days. There was no recurrence and the shape of flaps and the donor site were plum after a follow-up of 6 months to one year. Conclusions This combined treatment can be reliably adopted to cure patients with stage Ⅳ pressure sores, which can accelerate the healing of stage Ⅳ sores, improve the success rate of surgery and has a remarkable curative effect.
Kim P J, Attinger C E, Constantine T, et al. Negative pressure wound therapy with instillation: International Consensus Guide-lines update[J]. Int Wound J, 2020, 17(1):174-186.
[4]
Harries R L, Bosanquet D C, Harding K G. Wound bed preparation: TIME for an update[J]. Int Wound J, 2016, 13(3):8-14.
Ali E, Raghuvanshi M. Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy: a systematic review[J]. J Wound Care, 2017, 26(12):712-719.
Kim J T, Kim Y H, Naidu S. Perfecting the design of the gluteus maximus perforator-based island flap for coverage of buttock defects[J]. Plast Reconstr Surg, 2010, 125(6):1744-1751.
2021, Vol. 32 
