摘要
褥瘡的外科治療自從廣泛的使用板瓣手術後，褥瘡傷口大多能達到癒合目標，但是由於覆蓋部位大多仍無感覺以及病患對於預防褥瘡意識及教育不足，褥瘡復發的情形時常可見。相對於文獻上大量的褥瘡手術方法的介紹與評估，褥瘡復發的報告則不多見，本文探討以皮瓣手術治療的褥瘡病人經長期術後追蹤，其復發的情形如何？以級比較不同形式原發疾患及皮瓣手術的種類是否會影響褥瘡復發，慈濟醫院自77年8月至82年10月共有61位深度褥瘡病人接受82次皮瓣手術。皮瓣手術的被期成功率為95%，術後追蹤的時間最短為6個月，最長為5年8個月。在82個皮瓣手術部位中，有17例在同一部位發生復發，局部褥瘡復發為21%。而61位病中有25位在同一其他部位產生新的褥瘡。褥瘡病人複發率為41%。原發疾患為非外傷性非下身麻痺者共有18位病人，其局部褥瘡復發率為15.8%，褥瘡病人復發率為22.2%。原發疾患為外傷性下身麻痺共有43位病人，局部褥瘡復發率為22.2%，褥瘡病人復發率為48.8%；其復發率較原發疾患為非外傷性非下身麻痺高，至於不同形式的皮瓣手術方法其局部褥瘡複發率並沒有多大差異。由於褥雖經手術治療其復發率仍高，以在皮瓣的選擇上必需建立優先順序，以不影響到臨近其他將來可能使用的皮瓣血液供應者或能重覆使用者為優先考慮。另外更應注意如何選擇真正合適的病人接受皮瓣手術以及術後病患及家屬如何加強衛敎，以預防褥瘡的復發。
並列摘要
Closure of pressure sores with flap surgery has been used for a long time. Various types of muscles or musculocutaneous flaps have been used for the closure of sacral, ischial and trochanteric pressure sores, all with high operative success rates. In an effort to investigate the problem of sore recurrence, we reviewed data form 61 consecutive Gr Ⅲ to Ⅳ pressure sore patients on whom 82 flap surgeries were performed from August 1988 to October 1993 at Buddhist Tzu-Chi General Hospital. Follow up ranged from 6 months to 68 months, with a mean of 34 months. Despite a high initial operative success rate of 95% and a high initial healing rate, 21% of the sores operated on in a total of 41% of the patients underwent recurrent ulceration. There was a higher recurrence rate in patients with traumatic paraplegia etiology. There was a 20% recurrence of pressure sores that were closed with musculocutaneous flaps, and a 21.3% recurrence of those that were closed with skin flaps. The recurrence rate after surgical repair of pressure sores is high despite continued improvements in surgical techniques. Considering this high rate of recurrence, preventive measures including patient selection is important. Flaps that can be reused or do not preclude future use of adjacent flaps should be used as first line procedure.
延伸閱讀
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- 王健豪（2016）。願褥瘡不再現。人醫心傳－慈濟醫療人文月刊，(153)，74-77。https://www.airitilibrary.com/Article/Detail?DocID=P20141210001-201609-201609290008-201609290008-74-77
- Tsai, S. L., Chou, Y. Y., Liu, T. H., Wang, C. H., Chen, S. G., & Tzeng, Y. S. (2021). 以包含闌尾切除手術疤痕皮膚全層植皮重建化膿性汗腺炎傷口－病例報告. 臺灣整形外科醫學會雜誌, 30(2), 101-108. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-202106-202109090018-202109090018-101-108
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