目的 探讨Ⅳ期褥疮的治疗方法与效果。方法 选取武警辽宁总队医院2015-01至2018-12收治的23例(34处创面)Ⅳ期褥疮患者,褥疮分布:骶尾部15处,股骨大转子部10处,坐骨结节6处,踝部3处。创面范围4 cm× 5 cm ~7 cm×12 cm。采用全身治疗、创面床准备、皮瓣或肌皮瓣以及术后处理等综合治疗。其中,6处创面采用局部皮瓣修复,臀大肌肌皮瓣8处,阔筋膜张肌肌皮瓣10处,臀上动脉穿支皮瓣5处,腓动脉穿支皮瓣3处,股后皮神经营养血管皮瓣2处。结果 23例全身营养状况明显改善,血糖和血压控制良好。肉芽组织红润,创面分泌物减少,创周无红肿。术后皮瓣全部成活,皮瓣术后12~14 d拆线,创面愈合,住院22~36 d,平均29 d。随访6~12个月,原手术部位无褥疮复发, 皮瓣供受区外形饱满。结论 采用综合方法治疗Ⅳ期褥疮能促进创面愈合,手术成功率高,疗效可靠。

Objective To explore the treatments and therapeutic effect of stage Ⅳ pressure ulcer. Methods Between January 2015 and December 2018, 23 patients with 34 stage Ⅳ pressure sores were admitted to the First Department of General Surgery of Liaoning Provincial Corps Hospital of Chinese People's Armed Police Force, including 17 males and 6 females, aged 48 to 78. The wounds were located in the sacrococcygeal region in 15 cases, in the greater trochanter of the femur in 10 cases, in the ischial tuberosity in 6 cases, and in the ankle in 3 cases. The wounds ranged from 4 cm× 5 cm to 7 cm×12 cm in size. The patients underwent combined treatment, including systemic treatment, wound bed preparation, flaps or myocutaneous flaps, and postoperative management. Six wounds were repaired by local flaps, 8 by gluteus maximus myocutaneous flaps, 10 by tensor fascia lata island myocutaneous flaps, 5 by superior gluteal artery perforator island flaps, 3 by peroneal artery perforator flaps, and 2 by neurocutaneous femoris posterior flaps. Results The general nutritional status of these patients was improved. Blood pressure and blood glucose were under effective control. Granulation tissue turned fresh, necrosis tissue was removed, secretion reduced and no redness or swelling occurred in wounds. All the flaps survived. The sutures of flaps were removed in 12 to 14 days postoperatively and the wounds healed. Hospital stay ranged from 22 to 36 days and averaged 29 days. There was no recurrence and the shape of flaps and the donor site were plum after a follow-up of 6 months to one year. Conclusions This combined treatment can be reliably adopted to cure patients with stage Ⅳ pressure sores, which can accelerate the healing of stage Ⅳ sores, improve the success rate of surgery and has a remarkable curative effect.