负载万古霉素硫酸钙联合第4腰动脉穿支皮瓣治疗骶尾部Ⅳ期压疮疗效分析  

Clinical Efficacy of Vancomycin⁃impregnated Calcium Sulfate Combined with the Fourth Lumbar Artery Perforator Flap in the Treatment of Sacrococcygeal Pressure Ulcer of StageⅣ

作　　者：石定 苟军全[1] 刘宗义[1] 荣向科[1] 宋永斌 马芮 徐春娟[1] SHI Ding;GOU Junquan;LIU Zongyi;RONG Xiangke;SONG Yongbin;MA Rui;XU Chunjuan(Department of Burns and Plastics,The 987th Hospital of the PLA Joint Logistic Support Force,Baoji,Shaanxi 721004,China)

机构地区：[1]中国人民解放军联勤保障部队第九八七医院烧伤整形科,陕西宝鸡721004

出　　处：《中国烧伤创疡杂志》2023年第5期345-348,共4页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：目的分析探讨负载万古霉素硫酸钙联合第4腰动脉穿支皮瓣治疗骶尾部Ⅳ期压疮的临床效果。方法给予2017年10月至2021年3月中国人民解放军联勤保障部队第九八七医院收治的15例骶尾部Ⅳ期压疮患者在全身综合治疗的基础上,局部创面于清创、负压封闭引流治疗后行负载万古霉素硫酸钙联合第4腰动脉穿支皮瓣移植治疗,观察创面愈合情况。结果15例患者均顺利完成第4腰动脉穿支皮瓣移植修复手术,术中切取皮瓣面积为6.0 cm×7.0 cm~10.0 cm×19.0 cm,术中出血量为60~800 ml;术后,除1例患者因低蛋白血症致皮瓣边缘持续渗液、感染出现部分坏死、1例患者因皮瓣过长致远端血运不佳出现部分坏死,经清创、换药、营养治疗后创面乙级愈合外,其余13例患者术后皮瓣均完全成活,创面甲级愈合,愈合时间为8~19 d;术后随访3~36个月,所有患者愈后皮肤颜色、弹性、感觉等均恢复良好,压疮无复发,供区创面愈后皮肤无明显瘢痕增生。结论负载万古霉素硫酸钙联合第4腰动脉穿支皮瓣治疗骶尾部Ⅳ期压疮,能有效控制术后创面感染,皮瓣成活率较高,有利于压疮创面愈合,临床应用价值较高。Objective To analyze the clinical efficacy of Vancomycin-impregnated Calcium Sulfate combined withthe fourth lumbar artery perforator flap in the treatment of sacrococcygeal pressure ulcer of stageⅣ.Methods 15 patients with sacrococcygeal pressure ulcer of stageⅣadmitted into The 987th Hospital of the PLA Joint Logistic Support Force between October 2017 and March 2021 were given systemic comprehensive treatments,and their local wounds were managed with Vancomycin-impregnated Calcium Sulfate plus the fourth lumbar artery perforator flap grafting after debridement and vacuum sealing drainage.The wound healing condition was observed.Results All the 15 patients underwent the fourth lumbar artery perforator flap grafting successfully.The harvested flap size was 6.0 cm×7.0 cm-10.0 cm×19.0 cm,and the intraoperative blood loss was 60-800 ml.One patient suffered prolonged seepage and infection due to hypoproteinemia,which led to partial necrosis of peripheral flaps,one patient experienced partial necrosis of flaps due to poor distal bloodcirculation resulting from excessive length of flaps,and the two patients both realized secondary healing after debridement,dressing change and nutritional support.The flaps of the other 13 patients all survived,and the wounds realized primary healing,with the healing time of 8-19 days.During the follow-up 3-36 months after surgery,the healed skin of all patients showed excellent recovery of skin color,elasticity and sensation and no relapse of pressure ulcer,and the healed skin on the donor sites presented no obvious scar hyperplasia.Conclusion The combined application of Vancomycin-impregnated Calcium Sulfate and the fourth lumbar artery perforator flaps in the treatment of sacrococcygeal pressure ulcer of stageⅣcan effectively control postoperative wound infection,enhance the survival rate of flaps,and facilitate wound healing,presenting high value of clinical application.

关 键 词：压疮 第4腰动脉穿支皮瓣 负压封闭引流 万古霉素 硫酸钙 

分 类 号：R632.1[医药卫生—外科学]