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題名 | Reconstruction of Ischial Pressure Sore--A Review of a 10-Year Experience in a Single Institute=坐骨壓瘡重建--高醫十年經驗 |
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作者姓名(中文) | 陳克剛; 張高評; 黃書鴻; 林幸道; 賴春生; 李書欣; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 19:2 2010.06[民99.06] |
頁次 | 頁128-137 |
分類號 | 416.413 |
關鍵詞 | 坐骨壓瘡; 壓瘡重建; 皮瓣; Ischial pressure sore; Pressure-sore reconstruction; Flap; |
語文 | 英文(English) |
中文摘要 | 背景: 坐骨壓瘡和坐姿產生的壓力有關,外科清創與重建的角色已經廣為接受。但因為大多數患者皆年輕且下肢癱瘓,所以復發也成為這些患者終身的問題。 目的及目標: 本篇提供本院十年來的臨床經驗,並且依據我們的經驗提出建議的重建皮瓣選擇順序以供參考。 材料及方法: 從1999年4月到2009年03月,一共有126個坐骨壓瘡並人接受手術,其中40個病人接受重建皮瓣手術來重建傷口。32個病人接受完整的術後追蹤,故包含在此次研究中。總共使用60個皮瓣。我們將這些皮瓣分成三組;(1)筋膜皮瓣,(2)肌或肌皮瓣,以及(3)合併筋膜及肌肉皮瓣。我們以Kaplan-Meier method來分析皮瓣的無壓瘡存活率。 結果: 在這六十個重建皮瓣中,復發率有50%。復發的時間從三個月到七十二個月(平均為25.3月)。雖然初期筋膜皮瓣的存活率較好,長時間看來筋膜皮瓣和肌或肌皮瓣的存活率相當。而對於反覆復發的病人,合併筋膜及肌肉皮瓣可達到較好的無壓瘡存活率。 結論: 根據這些資料以及經驗,教育病人及家屬預防壓瘡的復發十分重要,但若不幸仍有復發的情形,我們提出皮瓣選擇的順序。穿透枝筋膜皮瓣是重建的首選,肌或肌皮瓣使用在復發的情形,而對於反覆的復發,我們可以使用合併筋膜及肌肉皮瓣(合併股薄肌及V-Y股深動脈穿透枝皮瓣)得到良好的結果。 |
英文摘要 | Background: The ischial pressure sore is associated with pressure in the sitting position. The roles of surgical debridement and flap reconstruction are well-established. However, most of the patients are young and paraplegic, and the recurrence of their pressure ulcers is an important issue during their lifetime. Aim and Objectives: This study provides our experiences in the reconstruction of ischial pressure sores. Based on these results, we propose a rationale for flap selection in the reconstruction of ischial pressure sore. Materials and Methods: From April 1999 to March 2009, there were one hundred and twenty-six ischial pressure-sore patients operated on at Kaohsiung Medical University Hospital. Forty patients underwent reconstructive flap surgery for definitive wound closure. Thirty-two patients (twenty-one men and eleven women) with long-term follow-up data were included in this study. A total of sixty flap operations were performed during the period. We categorized the transferred flaps into three groups: fasciocutaneous flap, myocutaneous or muscle flap, and combination of fasciocutaneous and muscle flaps. Ulcer-free survival rate was analyzed using the Kaplan-Meier method. Results: The recurrence was recognized in thirty of sixty pressure sores (50%). The period of recurrence ranged from three months to seventy months with a mean of 25.3 months. The fasciocutaneous flap had better survival in early follow-up. However, the myocutaneous and muscle flaps have comparative survival to that of the fasciocutaneous flap over long periods. The combined fasciocutaneous and muscle flap achieved better pressure sore-free survival in the patients with recurrent ischial pressure sore. Conclusion: Based on these results and experiences, we present our rationale for flap selection. The perforator-based fasciocutaneous flap is the initial choice of reconstruction. The muscle or myocutaneous flap can be used in the condition of recurrence. The combined fasciocutaneous and muscle flap (combined gracilis muscle flap and V-Y profunda femoris artery perforator-base flap) is suggested for reconstruction of intractable recurrent ischial pressure sores. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。