褥瘡的外科治療

Surgical Management of Pressure Sores

鄭立福(Li-Fu Cheng) ； 王先震(Hsian-Jenn Wang) ； 劉宏川(Horng-Chuan Liu) ； 陳天牧(Tien-Mu Chen) ； 湯有銘(Yeou-Ming Tung) ； 鄭天宇(Tian-Yeu Jeng)

《中華民國重建整形外科醫學會雜誌》 1卷1期 (1992/02) Pp. 52-60

https://doi.org/10.7096/JPRSA.199202.0052

摘要

褥瘡的治療一直是重建整形外科的重要範疇之一，1938年首先被報告出來，至第二次世界大戰由於麻醉、抗生素及輸血技術的發達，使得褥瘡的治療邁向劃時代的進步。三軍總醫院自民國七十四年一月至七十九年六月總共在二三○位病人中，治療二六八個褥瘡，其中有一三一個褥瘡接受一四六次外科手術治療，包括有(l)植皮術(STSG)有廿例，(2)鄰近轉移皮瓣(Regional rotation flap)有51例，(3)肌肉轉移皮瓣(Muscle rotation flap)有2例，(4)肌肉－皮層皮瓣(Myocutaneous flap)有72例及(5)兩側髖關節截肢(Bilatral hip disarticulation)有1例。
鄰近轉移皮瓣運用於第二、三及四級薦部、轉子部及坐骨部位等褥瘡有31例，併發症有11例佔35.5%，其復發率為32.3%。另外，先前採行骨突部分切除術及運用肌肉皮瓣當做襯墊的病人有74例，併發症有11例佔14.9%，其復發率為12.3%。
我們結論是第三級與第四級之薦部、轉子部及坐骨等部位的褥瘡手術治療，以採行骨突部分切除術及肌肉皮層皮瓣或肌肉轉移皮瓣優於簡單的鄰近皮瓣轉移術。另外，手術後的照顧與復健是預防復發的不二法門，因此(1)改善褥瘡形成的因素及(2)教育病人及家屬的壓力意識的觀念(Pressure consciousness)與外科手術治療是相輔相成的。

關鍵字

褥瘡、壓瘡 ； 薦部褥瘡 ； 轉子部褥瘡 ； 坐骨壓瘡 ； 鄰近轉移皮瓣 ； 肌肉－皮層皮瓣 ； 壓力意識

並列摘要

The management of decubitus ulcers is challenging and complex, which can be taxing on the surgeon's skill, ingenuity, arid imagination. These patients, usually partially or completely immobilized, have recurred multiple sores on different parts of their trunk & extremities.
We evaluated 230 patients with 268 decubitus ulcers. There were 131 pressure sores received operative closure during a 5-year period. Approximately half of them were classified grade II to IV, and were treated by musculocutaneous flap or regional rotation flap coverage. Indications, and follow-up results are presented.
The common postoperative complications included hematoma, infection, partial flap necrosis and dehiscence. The complication rate of local flap is 35.5%, and 14.9% in musculocutaneous flap.
Beside a definitive reconstructive procedure, the postoperative care, including modifying the factors that contribute to ulcer formation and teaching ”pressure consciousness” to the patient family are all essential.

並列關鍵字

Pressure sores ； Sacral Sores ； Trochanteric Sores ； Ischial Sores ； Regional Rotation flap ； Myocutaneous flap ； pressure Consciousness