Sacral Pressure Sores Research Articles

Stepladder V-Y advancement flaps for resurfacing various shaped defects of the sacrogluteal region

Gluteal stepladder V-Y advancement musculocutaneous and fasciocutaneous flaps were used for resurfacing of various shaped sacrogluteal defects. A total of 27 patients with sacrogluteal defects were treated using this technique. Twenty-four patients had sacral pressure sores, 2 patients had a pilonidal sinus, and 1 had a low thermal burn of the gluteal region. The shape of defects varied including 12 elliptic, 5 inverted heart-shaped, 4 pentagon, 4 diamond, and 2 other shapes. There were no problems regarding flap survival even at the tip of step segments. In all patients, easy resurfacing of the defects and satisfactory recontour of the gluteal region was obtained without linear scars crossing the gluteal fissure. Since the segments of the flap are similar to the defect, defects of various shapes are easily covered, and trimming of normal skin tissue becomes unnecessary or minimal. On inserting a triangular flap in the gluteal fissure, excellent recontour of the sacrogluteal region can be achieved.

A new postoperative management scheme for preventing sacral pressure sores in patients with spinal cord injuries.

Although the reliability of pressure sore surgery has improved with the advent of many different types of flaps, it is well known that the recurrence rate of pressure sores is still remarkably high in spinal cord-injured patients. This article reports the very low relapse rate of postsurgical pressure sores using air mattresses, which also helps relieve manpower requirements for care. We measured interface pressures at the sacrum for 18 spinal cord-injured patients with a ROHO air mattress (ROHO International, Inc, Belleville, IL). Based on the results, we used this mattress immediately after surgery for 19 spinal cord-injured patients with sacral pressure sores. Minimal repositioning was performed for each patient during the hospital stay. Minimal repositioning was similarly performed at home. All pressure sores healed, regardless of the type of surgical procedure, size, and degree of sore. No relapse has been found, with an average of 33.4 months after surgery. With this management, we could achieve a very low recurrence rate, require less manpower for postoperative management, as well as minimize stress for the patients.

Gluteus Maximus Fasciocutaneous V-Y Advancement Flap for Coverage of Sacral Pressure Sore

Gluteus Maximus Fasciocutaneous V-Y Advancement Flap for Coverage of Sacral Pressure Sore

Fecal diversion in management of large infected perianal lesions.

The purpose of this manuscript is to present a method of temporary fecal diversion. A tube was sutured into the anorectum of eight patients with large infected and/or necrotic perianal lesions that were being soiled and infected by the fecal stream. Five patients were diabetic, two had sacral pressure sores, and one suffered from hidradenitis suppurativa. Tubes remained in place from 10 to 14 days, during which time the infective condition was brought under control. There were no complications. The difficulties and disadvantages of current medical and surgical methods of controlling the fecal stream under these conditions are discussed, and the method presented is suggested as a viable and simple alternative.

Bilateral Gluteus Maximus V-Y Advancement Musculocutaneous Flaps for the Coverage of Large Sacral Pressure Sores: Revisit and Refinement

Surgical management of the sacral defect using the gluteal muscle or musculocutaneous flap has been well accepted over the years. In this study, refinements in the bilateral gluteus maximus V-Y advancement musculocutaneous flaps were made. These refinements include having sharper angle (60 degrees or less) at the donor sites of the flap, cutting the edges of the gluteal muscle of 3 cm beyond the skin flap, and cutting most parts of the gluteal muscle at a depth of only 2.5 cm (at the level of upper third portion). These improvements result in less tension closure of the donor site, easier closure of the advanced flaps in two planes without tension, and better preservation of most parts of the gluteal muscular insertions to the femur and their functions. The design of V-Y advancement has successfully maintained the superior and inferior gluteal vessels and inferior gluteal nerve. In this study, the average sacral defect was more than 12 cm in diameter, and each advanced flap was 15 x 12 x 3 cm in size. Of the 63 consecutive patients undergoing bilateral gluteus maximus V-Y advancement musculocutaneous flaps with refinements for coverage of large sacral pressure sores, 59 (93%) achieved complete healing after an average follow-up period of 28 months. Only 4 patients had recurrences of sacral sore. In this study, the duration of hospital stay for flap coverage averaged 38.5 days. Four patients (6%) had superficial dehiscences of the donor site requiring skin grafting. Ten patients (16%) developed stitch abscesses and 9 patients (14%) had wound infections, but no flap was lost. No significant functional impairment related to the flap procedure was noted. The operative technique described in this paper is not only simple and noninvasive, but with our refinements of flap design, the bilateral gluteus maximus V-Y advancement musculocutaneous flaps also provide reliable and durable coverage for large sacral pressure sores.

Multidisciplinary management of a pressure sore in the community.

A study of the care of a patient with a sacral pressure sore following bilateral lower limb amputation.

The use of an airwave mattress for pressure relief.

A report on the care of a patient who developed a sacral pressure sore after being admitted to hospital with a fractured hip.

Use of Limberg Flap for Closure of Sacral Pressure Sores

SummaryLimberg flap has been used for the closure of moderate size sacral pressure sores in 5 cases. It provides a good padded skin cover with the suture line away from the midline which is the area of ulceration. No breakdown or ulceration in the flap or donor defect suture line were seen during 1-4 years of follow up. Operative technique is briefly described and important points on flap planning are discussed.

大殿筋筋膜皮弁による仙骨部潰ようの治療 Ｖ‐Ｙ ａｄｖａｎｃｅｍｅｎｔ法による

A new V-Y advancement flap using the gluteus maximus fasciocutaneous flap is described. The skin, subcutaneous fat and gluteus maximus fascia are cut, but not the muscle belly. Thirteen patients with sacral pressure sores and radionecrosis underwent surgery using this method. Eleven of 13 patients experienced complete wound healing. In comparison with the conventional V-Y gluteus maximus musclocutaneous flap, this technique is easier and can achieve a better functional prognosis.

Surgical treatment of a sacral pressure sore by plantar flap in a paraplegic patient

Sacral pressure sores are frequent in paraplegic patients and are always complex to treat. We report the case of a paraplegic patient with a fractured leg, in which the circumstances leading to the development of the sacral ulcer also gave rise to an original method of treatment. After the fracture showed no tendency to spontaneous union, the leg was amputated and a pedicled plantar flap was used to cover a large sacral loss of substance.

仙骨部じょくそうの外科的治療

Recently, various techniques have been used to cover sacral pressure sores. These include skin grafts, local flaps, musculocutaneous flaps and fasciocutaneous flaps.We investigated how to decide which technique should best be used for managing sacral pressure sores of individual patients.The points are (1) confidence, (2) damage to patient, (3) surgical technique, (4) infection, (5) sore size, and (6) recurrence of sore.Our first option has been the use of local flaps where possible. However, when local flaps cannot be applied, we recommend the use of musculocutaneous flaps.

Continent urinary diversion and diverting colostomy in the therapy of non-healing pressure sores in paraplegic patients.

Immobilization and subsequent sacral decubitus or pressure sore formation is a danger faced by the paraplegic. We report on 4 patients treated with non-healing pressure sores. Three male patients had decubiti eroding into the posterior urethra and bladder neck area. One female patient had bladder neck and urethral loss secondary to Foley catheter erosion and a sacral pressure sore. All 4 had non-healing decubiti secondary to urinary contamination and, in addition, gross fecal contamination in the male patients. All patients failed previous muscular flaps and urinary diversion per suprapubic tube. In the male patients, suprapubic continent urinary diversion included bladder neck mobilization, closure of the distal urethra by oversewing and patching with bovine dura, and augmentation of the bladder with a Miami pouch. Fecal diversion was provided with a sigmoid colostomy. In the female patient, continent diversion was performed by forming a Miami pouch. Total diversion allowed healing of the pressure sores and provided a simpler method of personal hygiene. Details of the diversion and case studies will be presented.

Endogenous potentials in two different models of human skin injuries

The present study deals with endogenous potentials of skin injuries in humans and their role in the healing process. Two different models of injured skin were examined: experimental abrasion on forearm and sacral pressure sore. The preliminary results consistently demonstrate positive and markedly higher potentials at the injury sites of both types of wounds (ranging from 22 to 54 mV), compared with the potential of intact skin surface. The effects of electrical stimulation on endogenous potentials of pressure sores were also investigated.

仙骨部じょくそうの手術療法 術式の選択について

In recent years, advances in reconstructive surgery have led to the development of various operative methods for the treatment of sacral pressure sores, and favorable results have been reported with these nethods. In cases where sacral pressure sores are less than moderately sized, reconstruction is available using well-defined methods. However selection of the operative mode is very important because of the possibility of recurrence. This report discusses selection of surgical methods in cases with moderately sized or larger sacral pressure sores.Local cutaneous and fasciocutaneous flaps should be selected without regard to the patient's age in those cases where full social recovery is posible. Localcutaneous flaps in the juvenile, and fasciocutaneous and musculocutaneous flaps in the aged should be selected in those cases on which full social recovery is impossible.

Treating a patient with a sacral pressure sore.

The successful treatment of a large sacral pressure sore with calcium sodium alginate dressings is described.

Treating a pressure sore with PEME.

An explanation of pulsed electromagnetic energy therapy and a description of its use in the treatment of an 85-year-old woman's sacral pressure sore.

筋皮弁術を用いたじょく創の治療

We surgically treated 11 patients with decuditus ulcers during the 3-year period from 1988 to 1991. Of these 11 patients, 4 were treated with a local flap and the other 7 with a musculocutaneous (M-C) flap.The 7 cases who were successfully treated with an M-C flap comprised 5 women and 2 men ranging in age from 65 to 90 years (mean: 78.86 years); Five had sacral pressure sores, 1 had a greater trochanter pressure sore. Lesions ranged in size from 5.0×4.0cm to 10.5×8.5cm (mean: 7.5×5.4cm) and all were evaluated as Campbell type 5.Surgical treatment with an M-C flap produced a gratifying result, campletely curing the decubitus ulcers in all 7 patients. However one patient with a right greater trochanter pressure sore and concurrent diabetes mellitus died of pneumonia 4 months post-operatively.

Transverse Lumbar Flap for Sacral Bed Sores

Over the last 30 months, we covered all the 21 cases of sacral pressure sores admitted to our section with the transverse lumbar flap. All the flaps survived. The rationale of the flap design, its technique, and complications are described. The advantages and the drawbacks of the flap are also described. One of the major principles of bed-sore flaps, i.e., that the flap should be as large as possible, need not be adhered to.

The Outcome of CPR Initiated in Nursing Homes

To determine outcomes following attempted cardiopulmonary resuscitation initiated in nursing homes, we retrospectively reviewed ambulance and hospital records for all 705 people aged 65 or over who underwent attempted resuscitation by ambulance crews in 1987 in Baltimore City and Baltimore County. From medic unit encounter forms we noted whether or not the address of origin was a nursing home and to what hospital the person was taken. Hospital records were then examined to determine outcomes: death in the emergency room, death during consequent hospitalization, or live discharge. Complete information was obtained for all 117 nursing-home residents and for 580 of 588 nonresidents. When attempted resuscitation was begun in a nursing home, only two patients survived to hospital discharge, whereas 61 nonresidents (11%) survived after a mean stay of 14 days. Of the 115 nursing-home residents who did not survive to hospital discharge, 102 (89%) were pronounced dead in the emergency room, two (2%) more died within 24 hours of admission, and the remaining 11 (9%) died after an average stay of five days. Of the 519 nonresidents who died before discharge, 433 (83%) were pronounced dead in the emergency room, 16 (3%) died in the first 24 hours, and 70 (14%) lived an average of nine days. One of the two nursing-home residents who survived was an 87-year-old woman who spent 30 days in the hospital and died eight months after returning to the nursing home, demented, cachectic, with a large sacral pressure sore.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous intrathecal lignocaine infusion analgesia: a case report of a nine-week'spinal'

Continuous intrathecal infusion of lignocaine was used for nine weeks in the control of pain from sacral chordoma not responding to opioid administration. In the period of infusion, sacral and calcaneal pressure sores healed as a consequence of improved patient movement by nursing staff and, possibly, continuous sympathetic blockade.