背景:压疮在治疗方面提出了重大挑战,通常表现出低成功率和复发倾向。患有神经损伤的儿童,如脊髓膜膨出和脊髓损伤的儿童特别容易发生压力性溃疡。尽管取得了进步,实现成功的重建仍然是一项艰巨的任务。容易形成压疮的常见部位包括骶骨和坐骨区域,以及骨骼突出区域。此外,观察到可归因于医疗设备促进步行的压力性溃疡。虽然许多压疮自发消退,保守的管理对一些人来说可能是无效的,尤其是在3期和4期溃疡的病例中,需要手术干预。各种手术技术用于治疗褥疮溃疡,然而,他们的管理没有普遍接受的黄金标准。本文介绍了我们在这一领域的制度经验,突出手术方法的差异,治疗结果,并发症发生率,和长期随访。
方法:本研究对11名儿童的病历进行了回顾性分析,年龄从10岁到17岁,患者出现广泛的压疮,对保守治疗措施无反应。数据收集从2017年2月到2022年6月。压疮影响了各个解剖区域,包括坐骨区域(5/11患者),骶骨区域(3/11患者),下肢(1/11患者),肘部(1/11患者),会阴区(1/11患者)。手术干预是所有病例的选择方法,采用诸如利用穿孔器进行重建手术的技术,带蒂皮瓣,和局部皮瓣。
结果:11例溃疡(3期和4期)患者接受了手术治疗。我们介绍我们使用手术方法的经验,包括带蒂的前外侧皮瓣,带蒂股薄肌皮瓣,螺旋桨皮瓣和局部皮瓣。在某些情况下,手术在住院60天或溃疡发生10年后进行.我们检查了住院时间,手术管理和患者满意度。患者术后随访5年。除观察到部分坏死的一个皮瓣外,所有皮瓣均存活。复发率为9.01%(1/11)。一名患者接受了另一次手术。总体结果令人满意。
结论:结论:我们的发现强调了皮瓣重建手术技术在小儿压疮治疗中的有效性。根据我们的经验和观察到的结果,我们主张在治疗过程早期考虑将重建手术作为可行的治疗选择,特别是3期和4期溃疡。这种方法不仅满足了患者的迫切需求,而且有望实现长期伤口愈合和预防复发。
BACKGROUND: Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up.
METHODS: This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps.
RESULTS: Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory.
CONCLUSIONS: Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence.