摘要目的 总结重度褥疮的临床治疗经验.方法 2007年8月至2011年6月,湖南省郴州市第一人民医院烧伤整形科收治21例重度褥疮患者,共43处Ⅲ～Ⅳ度褥疮创面,应用封闭负压引流技术,以及局部任意筋膜瓣、上位或下位臀大肌岛状肌皮瓣、下位臀大肌局部旋转肌皮瓣、股后皮神经营养血管皮瓣、阔筋膜张肌岛状肌皮瓣、游离背阔肌肌皮瓣和中厚皮片移植修复,配合翻身床,术后全程护理跟踪指导联合治疗.21例中有13例为多发性褥疮,其中有5处为Ⅲ度褥疮,以移植皮片封闭,3处非骶尾部Ⅲ度褥疮宽度＜2 cm,予扩创后直接拉拢缝合；8例为单个Ⅳ度褥疮.结果 21例43处创面均治愈,3例5处创面中有2处创面因引流不畅皮瓣下积液,重新放置引流管通畅引流后伤口愈合,另有3处创面皮瓣移植后伤口愈合不良,再次扩创二期缝合后伤口亦愈合,所有皮瓣(肌皮瓣)均成活良好.16例获2个月至2年2个月的随访,其中4例因出院后未按要求注意护理再次受压复发,其余均未复发.结论 综合应用封闭负压引流技术,多种皮瓣及移植皮片,配合翻身床及出院后护理跟踪指导,对重度褥疮进行治疗,能达到满意疗效.

abstractsObjective To summarize the experience in the treatment of severe pressure sore.Methods From Aug.2007 to Jun.2011,21 cases of severe pressure sore with 43 Ⅲ -Ⅳ degree lesions were treated with combination treatment,including vacuum sealing drainage technique,local fascia flaps,upper or lower gluteus maximus island myocutaneous flaps,lower gluteus maximus myocutaneous flap,neurocutaneous femoris posterior flaps,tensor fascia lata island myocutaneous flaps,free latissimus dorsi myocutaneous flaps,and skin graft,combined with stryker frame and nursing tracking guidance.13 of 21cases had multiple pressure sore.Among them,5 Ⅲ degree pressure sores were covered by skin grafting and 3 non-caudal Ⅲ degree pressure sores( ＜2 cm in width) were directly closed after debridement.8 of 21 cases had single Ⅳ degree pressure sore.Results All the 43 wounds healed completely.5 wounds in 3 cases had effusion under flap which healed after re-drainage.The wounds were not healed in 3 cases with flap transposition which were also healed after re-debridement.All the flaps survived completely.16 cases were followed up for 2-26 months.Recurrence happened in 4 cases after discharge because of not following the required nursing care.Conclusions Comprehensive application of vacuum sealing drainage technique,multiple myocutaneous flaps and skin grafting,combined with stryker frame and nursing tracking guidance after discharge can be used for the treatment of severe pressure sore with satisfactory results.