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• W2896748723 abstract "INTRODUCTION:Pressure ulcers are localised areas of tissue necrosis that developwhen soft tissue is compressed between a bony prominence and anexternal surface for prolonged periods of time. They have been reportedthroughout history (in the Bible, Lazarus, Job and Isaiah, among others,are thought to have had pressure ulcers) and in Egyptian mummies .The terms decubitus ulcer and pressure sore have beeninterchanged inappropriately over the years. Technically, the termdecubitus ulcer refers to wounds developed over bony prominences whilein the recumbent position (ie, sacrum, heel, occiput); the Latin decumberemeans “to lie down.” Therefore, semantically, wounds acquired fromextended pressure in the seated or turned position (ie, ischial ortrochanteric ulcers) are not decubitus ulcers. Therefore, in general,wounds acquired from pressure over bony prominences can always becalled pressure sores. Shallow and superficial pressure ulcers are treated conservatively.Deep ones, with expressive underlying bone prominence in which no regression is on-going, are better to be treated operatively, if possible. Thus the hospitalisation period and the need for frequent dressings are shortened, preventing enormous scars and the risk of subsequent infection. Early and successful management of pressure sores ensures early rehabilitation of the patient. AIM OF STUDY:The main objectives of this clinical study are1. To evaluate the clinical results after a surgical reconstruction of pressure sores2. To discuss the types,anatomical regions,planning and techniques of reconstuctive methods.3. To analyse the merits and demerits of individual reconstructive option.4. To identify aetiology and patient risk factors for pressure ulcers development.5. To study the post operative management , risk factors for recurrance and complications6. To formulate a reconstructive protocol for pressure sore, based on the outcomes of the study and existing literatue ,at the same time keeping in mind the resources available.MATERIALS AND METHODS:Materials:This work includes the study of 50 patients who underwent reconstruction for pressure sores at the Department of Plastic surgery, Government Rajaji Hospital, Madurai. The patients who were admitted Orthopaedics, Neurology, Neurosurgery, General Medicine and General Surgery wards and subsequently referred to Plastic Surgery at Government Rajaji Hospital, Madurai, were studied between October 2006 – April 2009.Methods:The methods include obtainiing history from patients, thorough clinical examination and necessary investigations and appropriate surgical reconstruction. Intraoperative, post operative complications werenoted and managed accordingly. Patients were advised regarding rehabilitaion and referred back to their respective departments and advised regular follow up. The patients were followed up every week fortwo month, then monthly for a period of six months. The maximum follow up was for a period of 6 months.All informations were entered in a proforma specially designed for this study.Methodology:The patient’s name,age, sex, history of presenting illness and itsduration was obtained. Past history of chronic medical and surgical illnessnoted. Personal history like smoking, alcohol consumption and dietpattern were obtained.Detailed physical examination of the pressure sore was made andtissue diagnosis was recorded and reconstruction plannedaccordingly.Neurological examination regarding sensory, motorimpairment, bladder, bowel control, presence of spasms and contractureswere noted.Basic investigations like blood Hb estimation, urine examination,blood sugar and renal parameters like urea, creatinine were done. Serumprotein levels were assessed. Wound Swabs for culture and sensitivitywere taken.X ray chest, X ray of the local part and ECG were taken.Hypoprotenemia was managed by appropriate nutritionalsupplementation. Infection was controlled by periodic debridement andantibiotics. Spasm relieved with Diazepam 5mg twice daily. Adequaterelief of pressure was obtained by change of position every 2 hours,avoidance of moisture and nursing in a water bed.OBSERVATION AND RESULTS:In the fifty pateints included in this study,the mean age was 46.36 years,with a range of 16- 80 years.72 % patients were male and 28% were female in our study. Female to male ratio was 1: 2.57. Traumatic Paraplegia low spinal level (T9 and below) was found to be the aetiology in 20 patients. Post traumatic paraplegia high spinal level and Post traumatic quadriplegia were present in 4 and 6 patients respectively. Tuberculosis and Tumour compression causing paraplegia were found in 3 patients each. Orthopaedic injuries like fracture neck of femur and fracture pelvis were the causative factors in 3 patients each. Pressure sore development due to alteration of conscious level were foundin 8 patients. The commonest Site was the sacrum, which was present in 34 patients, followed by Ischium and Trochanter in 10 and 6 patients respectively. Pressure sore of the patella and lateral malleolus was seen in one patient each, in combination with Trochantric sore. Medium sized pressure sore was noted in 42 % of patients. 14 patients had small pressure sores and remaining 15 had large pressure ulcers. The majority of patients, 30 in number, had a Stage 4 pressure sore. Stage 3 sores were found in 28% of patients. Only 6 patients requiring reconstruction had stage 2 ulcers. Sacral pressure sore reconstrution was performed with B/L VY Gluteus maximus myocutaneous flap in 7 patients and B/L rotation flap in 5 patients.The majority of the Ischial pressure sore were reconstruted with Inferior gluteal thigh fasciocutaneous flap, accounting 6 patients. Tensor Fascia lata flap was used for Trochantric sores in 6 patients. Limberg flaps were used in all sites of pressure sores to a total of 12 patients. Haematoma and wound dehiscence were the commonest complications, encountered each in 6 patients. The infection rate was found to be 10%, while flap necrosis, which were partial were found in 3 patients. In our 6 month follow up recurrance rate was found to be 10%. CONCLUSION:In Conclusion1. Sacral Pressure sores of Stage III and IV are best managed by one of the variants of Gluteus maximus myocutaneous flaps. Skin flaps can be used to reconstruct superficial Sacral sores.2. Tensor fascia lata myocutaneous flap and Inferior gluteal thigh fasciocutaneous flap are reliable reconstructive options for Trochantric and Ischial sores respectively.3. Effective prevention and management of anaemia and hypoalbuminaemia in addition to good nursing care reduces the incidence of pressure sores. Effective control of Infection by medical and surgical means in early stages, prevents progression of pressure sores, and promotes early healing.4. Trauma was the primary causative factor, leading to neurological damage in majority of patients, and prevention and control of road traffic accidents is of prime importance in primary prevention ofpressure sores." @default.
• W2896748723 created "2018-10-26" @default.
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• W2896748723 date "2009-08-01" @default.
• W2896748723 modified "2023-09-27" @default.
• W2896748723 title "Reconstruction of Pressure Sores" @default.
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