Observation of integrative treatment on the bedsores caused by chronic pressive trauma

Objective To summarize the methods and results of the surgical treatment of patients with trauma-induced ulcer.Methods From January 1997 to D ecember 2008,107 cases of paraplegiaduetosideparalysis,dementia in very old people with chronic stress and other causes of traumatic skin,soft tissue wound fester 382 wounds were treated with flaps,free skin graft,postoperative lavage and suction.The pressure sores were respectively located in sacrococcygeal region(121 wounds),greater trochanter of femur(96wounds),ischial tuberosity(63wounds),iliac region(48wounds),the thoracic and lumbar area(22 wounds),the heel(15 wounds),the scapular region(17 wounds).Sisty-nine cases were implemented the irrigation and suction after operation.Perioperative nutrition was used in patients with metabolic support treatment,severe cases of infection after continuous lavage and suction,to prevent further compression.Results Three hundred and four wounds were completely healed among the 382 wounds,158 wounds were repaired by the muscle flaps or musculocutaneous flaps,76 wounds by axial composite tissue flap,54 wounds by transplanting free skin grafts,16 wounds by suturing directly.Among the 78 wounds heal delayed,axial composite flaps wereused in 41 wounds,flaps in 31 wounds,free skin grafts in 6 w ounds.Methods of healing the delayed wounds:38 wounds were cured by suturing directly after debridementin the second phase,27 wounds by free skin grafts,13 wounds by dressing cured(an average of 17 d).Follow-up over 6 months,17 cases of wounds were recurren in situ stress,among whom 13 cases were transplanted free skin.Conclusions Improving the general nutrition,controling local bacterial infection,using t he healthy skin around the w ound,muscle,and the composite tissue flap repairing the wounds,and reinforcing the suction at the end of lavage,to prevent further compression,etc,are good for improving the cure rate and reducing the relapse rate of the chronic stress wounds.