Sacral pressure sores have been treated by a variety of surgical methods. complete treatment needs wide excision and coverage with healthy tissue which has constant and sufficient blood supply. Use of gluteus maximus muscle flap with or without overlying skin is a revolutionary method because of the reliability of blood supply. However, it is technically a little bit complicated, and future reconstruction for recurrent decubitus is especially limited in paraplegic patients. The development of gluteal perforator-based flap with para-sacral perforator introduce a new treatment modality for the sacral pressure sores. Total 10 cases of sacral pressure sores were treated with gluteal perforator-based flap. There were minimal postoperative complications except wound dehiscence in one case. This flap has a many advantage of no transection or sacrifice of the gluteus maximus muscle, elevation time for the flap is short, reliable blood flow of the perforator, large rotation arc and no post-operative hindrance to walking in patients who are not paraplegic. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for technically careful dissection.
Humans ; Postoperative Complications ; Pressure Ulcer* ; Skin ; Walking ; Wounds and Injuries

PURPOSE: Perforator flaps have been widely used for reconstruction of pressure sores because they have many benefits, especially reducing tension. Otherwise in order to prevent recurrence of a pressure sore, sufficient thickness of a flap is desirable, so a musculocutaneous flap is also useful for reconstruction of a pressure sore. Therefore, the authors considered about the postoperative results of reconstruction of pressure sores between using perforator flaps and musculocutaneous flaps. METHODS: In this study, 33 patients(46 flaps) who underwent reconstructive operation of pressure sores from January 2007 to February 2011 were reviewed. Patients operated by using perforator flaps were 18(18 flaps), and musculocutaneous flaps were 17(28 flaps). We studied postoperative complications and recurrence. RESULTS: We experienced five patients(10 flaps) with complications or recurrences who were operated using musculocutaneous flaps and one patient using a perforator flap. One case using a perforator flap stemmed from dehiscence caused by a urinary fistula occurring in two months after the surgery. Among ten cases using musculocutaneous flaps, one case was caused by total necrosis of flap, five cases by partial necrosis of flap and dehiscence, and four cases by recurrences during follow-up period. CONCLUSION: Even if more cases were required, it can be more considerable to operate using the perforator flap rather than the musculocutaneous flap to reduce the complication or recurrence of pressure sore.
Buttocks ; Follow-Up Studies ; Humans ; Necrosis ; Perforator Flap ; Postoperative Complications ; Pressure Ulcer ; Recurrence ; Urinary Fistula

Diabetic foot ulcers (DFU) are common and serious complications of diabetes mellitus. The prognosis of DFU may be very poor even during early stages depending on the general conditions of patients, and amputation is often required to manage DFU. Various therapeutic approaches to DFU have been introduced, and among these negative-pressure wound therapy using vacuum-assisted closure (VAC-NPWT) is particularly noteworthy. We performed VAC-NPWT in three patients with complicated DFU. We used a modified VAC-NPWT protocol, which used wall suction and curaVAC(R). Dressing changes were performed every week, which was longer than standard method. All of our cases improved with granulating wound beds and were cleared of bacterial infection by the end of modified VAC therapy. These modifications reduced the costs of VAC-NPWT without introducing associated side effects. We recommend the active application of VAC-NPWT for complicated DFU, although this recommendation should be confirmed by large randomized controlled studies.
Amputation ; Bacterial Infections ; Bandages ; Diabetes Complications ; Diabetic Foot ; Humans ; Negative-Pressure Wound Therapy ; Prognosis ; Suction ; Ulcer

OBJECTIVETo investigate the feasibility of debridement at early stage by combining lavation and drainage under continuous negative pressure in the limb salvage surgery of patients suffering from diabetic foot complicated by plantar abscess.

METHODSTen patients suffering from diabetic foot (10 feet affected) combined with plantar abscess were involved. After being debrided, wounds of patients were lavaged and drained for 7 - 14 ds under continuous negative pressure through a detained stomach tube. Suction under negative pressure continued for 3 - 5 ds after lavation, and then drainage tube was removed. Stitches on wound were removed about 3 weeks after surgery. The condition of the wounds was observed.

RESULTSAfter above-mentioned treatment, local inflammatory response of patients was obviously ameliorated, and the wounds healed with satisfactory preservation of function and shape of the feet.

CONCLUSIONSDebridement combined with local lavation and drainage under continuous negative pressure is satisfactory for the treatment of diabetic foot complicated by plantar abscess, and it can preserve the length of the affected limb.

Abscess ; complications ; surgery ; Aged ; Bacterial Infections ; complications ; surgery ; Debridement ; Diabetic Foot ; complications ; surgery ; Feasibility Studies ; Female ; Foot Ulcer ; complications ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy

Sacrum area is the high-risk area for pressure ulcer to persons with spinal cord injury. A finite element model of the soft tissue in the sacrum area was established to analyze the stress distribution in the soft tissue with the human body lying down. In addition, the muscle oxygenation in the sacrum area was assessed by near-infrared spectroscopy (NIRS) before and after loading pressures. The results showed that the stress was mainly localized in the muscle layer and the stress in the bone-tissue interface was the maximal. When the loading reached 10kPa, the maximal stress in the muscle layer was 15kPa. The muscle oxygenation parameters changed significantly with the applied pressure and returned to normal level after the loading.
Adipose Tissue ; Finite Element Analysis ; Humans ; Muscle, Skeletal ; metabolism ; Oxygen ; metabolism ; Pressure ; Pressure Ulcer ; complications ; physiopathology ; Sacrum ; Spinal Cord Injuries ; complications ; physiopathology ; Stress, Mechanical

PURPOSE: To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs). METHODS: Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance. CONCLUSIONS These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.
Humans ; Spinal Fractures/etiology* ; Pressure Ulcer/complications* ; Iran/epidemiology* ; Spinal Cord Injuries/epidemiology* ; Risk Factors ; Spine ; Registries ; Urinary Incontinence/complications* ; Suppuration/complications*

Ulcer in buttock is mainly a pressure sore, which is frequently occurred at the sacral region in Korea and its surgical treatment is chiefly the operation using gluteus maximus myocutaneons flaps. For the treatment of ulcerated lesion in gluteal area, various methods using gluteus maximus muscle have been developed. We reviewed and analyzed the 100 cases using gluteus maximus myocutaneous flaps in our department since 1980. The results were summarized as follows ; 1) The ratio between male and female was 3:1. 2) The prevalent age groups were between third and fifth decades. 3) The main cause was the trauma. 4) The wound culture showed the pattern of mixed infections in most cases, consisting of Staphylociccus, Pseudomonas, Enterococcus, Streptococcus, and others. 5) The postoperative complications were noted in about thirty percent of the cases. The complications were flap tip necrosis, wound infection, wound disruption, and others. 6) For the treatment of small ulcers, a pure skin flap or myoplasty may be used, but for the treatment of large one, a kind of myocutaneous flap should be selected. 7) Gluteus maximus myocutaneous flaps can be used as variable methods, but of which the island flap is ideal in deep and large ulcerated lesion.
Buttocks ; Coinfection ; Enterococcus ; Female ; Humans ; Korea ; Male ; Myocutaneous Flap* ; Necrosis ; Postoperative Complications ; Pressure Ulcer ; Pseudomonas ; Sacrococcygeal Region ; Skin ; Streptococcus ; Ulcer ; Wound Infection ; Wounds and Injuries

In modern society we have been gradually interested in the elderly and easily come into contact with many medical favors to enhance the quality of life, and the elderly are gradually increasing owing to the development of the basic science such as new diagnostic machinery, operative technique and development of the therapeutics. However, the variation of the environment has increased the possibility to be exposed to the dangerous factors, and it has given rise to the problems about the quality of the elderly life. It has also greatly enlarged in medical as well as social. Therefore, the frequency of the elderly reconstructive surgery to increase the quality of the elderly life by operation without life or death has increased in plastic surgery. So authors thought that the safe operative study is necessary. We reviewed the case of 102 elderly patients (65 years of age), who were operated during the period from 1988 to 1995, and analyzed the age & sex distribution, classification & distribution of diseases in elderly, operation of plastic & reconstructive surgery in elderly, anesthetic, methods, underlying diseases, and postoperative complications through the patient records. We also examined postoperative function, aesthetic improvement, progression of the quality of life by telephone and analyzed the elderly classification and elderly plastic & reconstructive surgery. The results are as follows : 1. There were benign neoplasm, facial bone fracture, aesthetic surgery, skin and soft tissue defect, complicated diabetic mellitus, malignant ulcer, malignant neoplasm, pressure sore in elderly diseases of plastic & reconstructive surgery. 2. We mainly performed skin graft, flap surgery, ORIF, aesthetic surgery. 3. The recovery rate after postoperative evaluation shows that ; 1) 52% of total interviewee feel that their QOL has improved. 2) 24% of total interviewee feel that their QOL has not changed. 3) 24% of total interviewee feel that their QOL has deteriorated. We report the point at issue and statistical examination with record investigation.
Aged* ; Classification ; Dermatologic Surgical Procedures ; Facial Neoplasms ; Fractures, Bone ; Humans ; Postoperative Complications ; Pressure Ulcer ; Quality of Life ; Sex Distribution ; Skin ; Surgery, Plastic* ; Telephone ; Transplants ; Ulcer

Marjolin's ulcer is a rare malignancy arising from various forms of scars, mainly an old scar resulted from burn. The second most common origin is malignant degeneration arising from tissue within osteomyelitis fistulae. Not uncommonly, the lesions may arise secondary to ulcers due to venous insufficiency or pressure sores. The pathology of the majority of Marjolin's ulcer is a well-differentiated squamous cell carcinoma. The exact reason for an ulcer which undergoes a malignant transformation is unknown. The pathologic diagnosis is the gold standard. Surgery remains the preferred treatment after diagnosis is reached. Wide surgical excision with margins up to 2-3 cm has been suggested. The necessity of whether lymphatic dissection should be executed, or radiotherapy and chemotherapy following surgery is still in dispute. This article deals with the etiology of Marjolin's ulcer and its pathological grading, diagnosis, treatment, prognosis, and prevention, with a hope to provide some useful clinical information.
Burns ; complications ; Carcinoma, Squamous Cell ; etiology ; pathology ; surgery ; Cicatrix ; Humans ; Lymphatic Vessels ; Pressure Ulcer ; pathology ; surgery ; Prognosis ; Skin Neoplasms ; etiology ; pathology ; surgery ; Skin Ulcer

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.
Aged ; Delirium ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Hip Fractures ; Humans ; Pneumonia ; Postoperative Complications ; Pressure Ulcer ; Pulmonary Edema ; Pulmonary Embolism ; Rupture ; Ulcer ; Urinary Bladder ; Venous Thrombosis