압박 궤양의 수술적 치료에 대한 임상적 연구

Abstract

Purpose: The incidence rate of pressure sore is increasing steadily, especially in old ages, chronic disease and paralytic patients. Most of patients need to surgical treatment. There has been many operative methods for reconstruction of pressure sore. The purpose of this study is to assess clinical analysis of surgical treatment according to presence or absence of paraplegia, each site and size, operation method, complication and recurrence in each sites and groups and to propose proper reconstructive methods for the each pressure sore group.

Methods: The author reviewed the data from 56 consecutive patients with 62 pressure sores from February 2008 to December 2010 to study the incidence and recurrence according to the site on the basis of the presence or absence of paraplegia and its etiology. These patients were categorized into three diagnostic groups: traumatic paraplegics(TP), nontraumatic paraplegics (NTP), and nontraumatic nonparaplegics(NTNP). The author evaluated the sites and sizes of each lesions, patient's state, primary causes of pressure sore, operative methods in each sites and groups, complications and recurrences on each groups.

Results: In 56 patients, 37 patients were male, 19 patients were female. The male to female ratio was 1.9: 1. Mean age was 48.2 years. 23 patients were in TP group, 12 in NTP group, and 21 in NTNP group, respectively. The common sites of pressure sore were sacral area(45.2%), greater trochanteric area(32.2%) and ischial area(22.6%). V-Y advancement flap was used for 7 cases of pressure sore on sacral area. Bilateral advancement flap were used for 10 cases of pressure sore on greater trochanteric area and 5 cases of pressure sore on ischial area. There were some complications such as infection, wound dehiscence, hematoma and partial flap necrosis. Infections and hematoma s were treated with antibiotics and I & D. Wound dehiscences were treated with debridement and primary closure. Partial flap necrosis was treated with 2ndary intention. In each group, recurrence and complication rate were 8.7%, 21.7% in TP, 8.3%, 8.3%in NTP and 9.5%, 19% in NTNP. Recurred pressure sores were covered with V-Y advancement musculocutaneous flap and rotational musculocutaneous flap.

Conclusion: Surgeons must consider the general condition of the patient and possibility of recurrence and returning of daily life. The author propose that less invasive operation methods such as cutaneous flap, fasciocutaneous flap and skin graft were considered primarily in highly recurrence rate group(NTNP) and site(sacrum). And then, although pressure sore was recurred, various alternative operation methods were successfully applied.

Key Words : Pressure sore