背景:压疮是一种常见的健康问题,特别是在老年和卧床不起的患者中,他们容易受到骶骨区域的压力伤害。目前,游离皮瓣和局部皮瓣手术是重建此类损伤的金标准程序。然而,皮瓣手术的复发率似乎很高。在这种情况下,我们介绍了一例涉及经皮移植重建的骶骨压疮。
方法:一名59岁男性,有丙型肝炎病史,脑出血,脑积水,多处骨折表现为骶骨溃疡.由于患者的复发性压力损伤的历史和与术后伤口护理相关的挑战,患者及其家人对进行皮瓣手术犹豫不决。
方法:患者被诊断为IV期压力性溃疡,骶骨面积为4厘米×4厘米,根据国家压力性溃疡咨询小组分期系统。
方法:手术前,患者接受了4个月的标准伤口护理,以及由于铜绿假单胞菌的伤口培养阳性而导致的短期口服抗生素。在手术过程中,从患者的左大腿上采集大小为35cm2、厚度为0.014英寸的真皮移植物。然后将移植物固定到伤口床上。
结果:尽管真皮移植物在1周后因脱落而失败,伤口床显示肉芽改善。1.5个月后,伤口面积减少到原来的一半,3.5个月后伤口最终愈合。
结论:真皮移植物在重建骶骨区压力性损伤伤口方面具有利基,因为即使在移植物失败的情况下,伤口护理也相对容易和额外的好处。
BACKGROUND: Pressure ulcers are a common health issue, particularly among elderly and bedridden patients who are vulnerable to pressure injuries in the sacral region. Currently, free flap and local flap surgeries are the gold standard procedures for the reconstruction of such injuries. However, the recurrence rate of flap surgery appears to be high. In this context, we presented a
case involving a sacral pressure ulcer reconstructed with dermal grafting.
METHODS: A 59-year-old male with a medical history of hepatitis C, brain hemorrhage, hydrocephalus, and multiple fractures presented with a sacral ulcer. Owing to the patient\'s history of recurrent pressure injuries and the challenges associated with postoperative wound care, the patient and his family were hesitant to proceed with flap surgery.
METHODS: The patient was diagnosed with a stage IV pressure ulcer measuring 4 cm × 4 cm in size in the sacral region, according to the National Pressure Ulcer Advisory Panel staging system.
METHODS: Before surgery, the patient received standard wound care with dressing for 4 months, along with short-term oral antibiotics due to a positive wound culture for Pseudomonas aeruginosa. During the surgery, a dermal graft with a size of 35 cm2 and a thickness of 0.014 inches was harvested from the patient\'s left thigh. The graft was then secured to the wound bed.
RESULTS: Although the dermal graft failed with sloughing after 1 week, the wound bed showed improvement with granulation. After 1.5 months, the wound area had decreased to half of its original size, and the wound eventually healed after 3.5 months.
CONCLUSIONS: Dermal grafts have a niche in reconstructing pressure injury wounds in the sacral region, because of the relative ease of wound care and additional benefits even in cases where the graft fails.