OBJECTIVETo investigate the clinical effect of subcutaneous undermining dissection with continuous negative pressure drainage for the closure of cystic cavity-type bedsore.

METHODS12 patients with cystic cavity-type bedsore underwent surgical debridement and the wounds were closed after subcutaneous undermining dissection. The negative pressure drainage was put in the deep space. The healing process was observed.

RESULTSCompleted healing was achieved in all the 12 cases. The skin wounds healed after 17-20 days and the deep spaces closed after 36-43 days. 12 cases were followed up for 1 year with no occurrence.

CONCLUSIONSIt is an easy and effective method to treat cystic cavity -type bedsore by subcutaneous undermining dissection with continuous negative pressure drainage.

Debridement ; methods ; Drainage ; methods ; Humans ; Negative-Pressure Wound Therapy ; Pressure Ulcer ; surgery ; Wound Healing

OBJECTIVETo study the effects of negative-pressure wound therapy (NPWT) on the treatment of complicated and refractory wounds.

METHODSSixty-seven patients with complicated or refractory wounds admitted to our hospital from September 2005 to November 2008 were randomly divided into NPWT group (n = 35) and conventional treatment (CT) group (n = 32). Wounds of patients in NPWT group were treated with interrupted suction under a pressure of -16.63 kPa for 24 hs, or continuous suction under a pressure of -10.64 kPa for 24 hs. Wounds of patients in CT group were covered with petrolatum gauze overlaid with isotonic saline gauze and dry gauze. Duration of treatment, times of operation, treatment cost, and the process of healing were compared between two groups.

RESULTSThe duration of treatment, treatment cost and times of operation of patients in NPWT group were obviously less or fewer than those of CT group (P < 0.05). Wounds of patients in NPWT group were mainly healed by themselves (40.0%) or healed after free skin grafting (40.0%). While wounds in patients in CT group healed mainly after tissue flap transplantation (66.7%) or free skin grafting (23.3%).

CONCLUSIONSCompared with CT, NPWT can shorten the length of hospital stay, reduce operation frequency and treatment cost, and it is easier to carry out in the surgery of treating complicated and refractory wounds, which is worth generalization.

Adult ; Aged ; Diabetic Foot ; surgery ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Pressure Ulcer ; surgery ; Wound Healing

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

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

Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.
Blood Loss, Surgical ; Debridement ; Female ; Humans ; Male ; Muscles/surgery* ; Osteomyelitis/surgery* ; Perforator Flap ; Pressure Ulcer/surgery* ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Objective: To explore the clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter. Methods: The retrospective observational study was conducted. From December 2018 to December 2021, 23 patients with sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter who met the inclusion criteria were admitted to Ganzhou People's Hospital, including 16 males and 7 females, aged 45 to 86 years. The size of pressure ulcers in ischial tuberosity ranged from 1.5 cm×1.0 cm to 8.0 cm×5.0 cm, and the size of pressure ulcers in greater trochanter ranged from 4.0 cm×3.0 cm to 20.0 cm×10.0 cm before debridement. After treatment of underlying diseases, debridement and vacuum sealing drainage for 5 to 14 days were performed. All the wounds were repaired by island posterior femoral composite tissue flaps, with area of 4.5 cm×3.0 cm-24.0 cm×12.0 cm, pedicle width of 3-5 cm, pedicle length of 5-8 cm, and rotation radius of 30-40 cm. Most of the donor site wounds were sutured directly, and only 4 donor site wounds were repaired by intermediate thickness skin graft from the contralateral thigh. The survival of composite tissue flaps, wound healing of the donor and recipient sites and the complications were observed. The recurrence of pressure ulcers, and the appearance and texture of flaps were observed during follow-up. Results: A total of 32 wounds in 23 patients were repaired by island posterior femoral composite tissue flaps (including 3 fascio subcutaneous flaps, 24 fascial flaps+fascio subcutaneous flaps, 2 fascial flaps+fascial dermal flaps, 2 fascial flaps+fascio subcutaneous flaps+femoral biceps flaps, and one fascial flap+fascio subcutaneous flap+gracilis muscle flap). Among them, 31 composite tissue flaps survived well, and a small portion of necrosis occurred in one fascial flap+fascio subcutaneous flap post surgery. The survival rate of composite tissue flap post surgery was 96.9% (31/32). Twenty-nine wounds in the recipient sites were healed, and 2 wounds were torn at the flap pedicle due to improper postural changes, and healed one week after bedside debridement. One wound was partially necrotic due to the flap bruising, and healed 10 days after re-debridement. Thirty-one wounds in the donor sites (including 4 skin graft areas) were healed, and one wound in the donor site was torn due to improper handling at discharge, and healed 15 days after re-debridement and suture. The complication rate was 12.5% (4/32), mainly the incision dehiscence of the flap pedicle and the donor sites (3 wounds), followed by venous congestion at the distal end of flap (one wound). During the follow-up of 3 to 24 months, the pressure ulcers did not recur and the flaps had good appearance and soft texture. Conclusions: The island posterior femoral composite tissue flaps has good blood circulation, large rotation radius, and sufficient tissue volume. It has a high survival rate, good wound healing, low skin grafting rate in the donor site, few postoperative complications, and good long-term effect in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter.
Male ; Female ; Humans ; Plastic Surgery Procedures ; Pressure Ulcer/etiology* ; Soft Tissue Injuries/surgery* ; Treatment Outcome ; Skin Transplantation ; Femur/surgery* ; Necrosis/surgery* ; Perforator Flap

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

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

OBJECTIVETo explore the feasibility and efficacy of the vacuum sealing drainage (VSD) technique combined with skin flap for the treatment of chronic ulcerative wounds.

METHODSFrom June 2009 to Aug. 2011, the VSD technique combined with skin flap has been applied in the treatment of 15 patients with chronic ulcerative wounds caused by various reasons. The VSD was applied to the wound for 1-6 times. When infection was controlled and fresh granulation grew, skin flap was used to cover the wound.

RESULTSFlap necrosis happened in a small area at the distal end in one case, which healed after skin graft. All the other flaps survived with primary healing. The patients were followed up for 6-24 months postoperatively with no recurrence of infection.

CONCLUSIONSVSD combined with skin flap is an ideal choice for reconstruction of chronic ulcerative wounds. It has the advantages of low complications, reliable flap survival rate, and low infection recurrence.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome ; Ulcer ; surgery

OBJECTIVETo investigate the clinical application of superior or inferior gluteal artery perforator flaps for the gluteal sores.

METHODSBefore operation, the perforator artery was detected by Doppler flowmeter and labeled. The perforator flap was designed, including the perforator artery, but not the gluteal maximum muscle.

RESULTSFrom Aug. 2006 to May 2009, 15 cases were treated. The flap size ranged from 6 cm x 8 cm to 7 cm x 15 cm. All the flaps survived completely without hematoma, seroma or other complication.

CONCLUSIONSThe gluteal maximum muscle-reserved gluteal artery perforator flap is a good choice for gluteal sore with reliable blood supply and less morbidity in donor site.

Adult ; Buttocks ; blood supply ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome