CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF 17 PATIENTS WITH PRESSURE SORE OF SINUS TYPE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIUYi , ZHANGXianying , XIAOBin , SONGMei , LIUPing , JIANGJiang , ZHANGCheng , ZHANGXusheng , CHENLiming

Center of Burns and Plastic Surgery of Chinese PLA, Lanzhou General Hospital of Lanzhou Military Command of Chinese PLA, Lanzhou Gansu, 730050, P. R. China;

Corresponding?author：

LIUYi, Email: liuyi196402@163.com

Keywords：

Pressure sore of sinus type; Second sinus; Wound repair

DOI：

10.7507/1002-1892.20140216

Video：

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Objective To sum up the clinical characteristics,surgical management,and effectiveness of pressure sore of sinus type. Methods Between January 2009 and April 2013,17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated,and the clinical data were analyzed retrospectively.There were 11 males and 6 females with an average age of 27.4 years (range,17-49 years).The median disease duration was 1.5 years (range,6 months to 7 years).Of 17 cases,there were 14 primary cases and 3 recurrent cases; 10 focuses of 8 cases were classified as simple sinus type,and 9 focuses of 9 cases as complex sinus type,which had a false synovial sheath complicated with one to four "second sinus".The pressure sore of sinus type majorly located at the ischial tuberosity.The size of pressure sore ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm,and the length of "second sinus" ranged from 8 to 32 cm with an average of 17 cm.After the false synovial sheath was totally excised,the wound was repaired by local sliding or rhombus flaps at the first or second stage in patients with simple sinus type pressure sore.On the basis of excising the false synovial sheath,the "second sinus" was totally removed in the patients with complex sinus type pressure sore. Results Wound dehiscence occurred in 1 case of simple sinus type pressure sore at 4 days,which was cured after it was sutured again.Wound infection occurred at 9,17,and 23 days respectively in 3 cases of complex sinus type pressure sore,which was cured after second debridement and necrosis tissues removal.The other wounds healed by first intention,and the flaps totally survived.All patients were followed up 6-12 months (mean,9.3 months).No recurrence was observed. Conclusion According to the clinical characteristics,pressure sore of sinus type could be divided into simple sinus type and complex sinus type.The key of successful treatment is to thoroughly excise false synovial sheath and "second sinus".

Citation： LIUYi, ZHANGXianying, XIAOBin, SONGMei, LIUPing, JIANGJiang, ZHANGCheng, ZHANGXusheng, CHENLiming. CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF 17 PATIENTS WITH PRESSURE SORE OF SINUS TYPE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 981-984. doi: 10.7507/1002-1892.20140216 Copy

1.	張春雷,張春陽,張建平,等.臀大肌肌皮瓣聯合真皮皮瓣修復骶尾部褥瘡.中國修復重建外科雜志,2011,25(6):763-764.
2.	Lindgren M,Unosson M,Krantz AM,et al.Pressure ulcer risk factors in patients undergoing surgery.J Adv Nurs,2005,50(6):605-612.
3.	戴亞琴,賈勤,朱紅英,等.30例雙側臀大肌肌皮瓣修復骶尾部巨大壓瘡的護理.護理學報,2013,20(2B):67-69.
4.	侍德.骨科修復重建手術學.上海:復旦大學出版社,2001:143-144.
5.	顧鶯,張玉俠,沈國妹,等.40例兒科病人院內枕部壓瘡發生的回顧性分析.中國護理研究,2013,27(5A):1226-1227.
6.	Black J,Baharestani M,Cuddigan J,et al.National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.Dermatol Nurs,2007,19(4):343-349.
7.	Janel E.Assessment and management of pressure ulcers in the elderly:current strategies.Drugs Aging,2010,27(4):311-325.
8.	李強,海恒林,李華濤,等.股外側斧頭形筋膜皮瓣修復雙側股骨大轉子部壓瘡11例.中華燒傷雜志,2013,29(4):397-399.
9.	張衛紅,朱旭.聯合治療Ⅳ度褥瘡創面的臨床體會.中華顯微外科雜志,2009,32(4):332-333.
10.	許喜生,馬錚錚,周永生,等.重度褥瘡的臨床治療經驗.中華整形外科雜志,2011,27(6):405-410.
11.	劉毅,張緒生,張誠,等.褥瘡的臨床分型與手術治療原則.中國修復重建外科雜志,2007,21(9):932-936.
12.	Kuroda S,Akimoto M.Finite element analysis of undermining of pressure ulcer with a simple cylinder model.J Nippon Med Sch,2005,72(3):174-178.
13.	Singh DJ,Bartlett SP,Low DW,et al.Surgical reconstruction of pediatric pressure sores:long-term outcome.Plast Reconstr Surg,2002,109(1):265-269.
14.	He J,Xu H,Wang T,et al.Treatment of complex ischial pressure sores with free partial lateral latissimus dorsi musculocutanrous flaps in paraplegic patients.J Plast Reconstr Aesthet Surg,2012,65(5):634-639.
15.	Aamer N,Muhammad U,Sakhi J.Prevalence of bed sores among spinal cord injured patients of Muzzafarahad and Bagh,Azad Jammu Kashmir.J Public Health and Biological Sciences,2012,1(1):19-22.

1. 張春雷,張春陽,張建平,等.臀大肌肌皮瓣聯合真皮皮瓣修復骶尾部褥瘡.中國修復重建外科雜志,2011,25(6):763-764.
2. Lindgren M,Unosson M,Krantz AM,et al.Pressure ulcer risk factors in patients undergoing surgery.J Adv Nurs,2005,50(6):605-612.
3. 戴亞琴,賈勤,朱紅英,等.30例雙側臀大肌肌皮瓣修復骶尾部巨大壓瘡的護理.護理學報,2013,20(2B):67-69.
4. 侍德.骨科修復重建手術學.上海:復旦大學出版社,2001:143-144.
5. 顧鶯,張玉俠,沈國妹,等.40例兒科病人院內枕部壓瘡發生的回顧性分析.中國護理研究,2013,27(5A):1226-1227.
6. Black J,Baharestani M,Cuddigan J,et al.National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.Dermatol Nurs,2007,19(4):343-349.
7. Janel E.Assessment and management of pressure ulcers in the elderly:current strategies.Drugs Aging,2010,27(4):311-325.
8. 李強,海恒林,李華濤,等.股外側斧頭形筋膜皮瓣修復雙側股骨大轉子部壓瘡11例.中華燒傷雜志,2013,29(4):397-399.
9. 張衛紅,朱旭.聯合治療Ⅳ度褥瘡創面的臨床體會.中華顯微外科雜志,2009,32(4):332-333.
10. 許喜生,馬錚錚,周永生,等.重度褥瘡的臨床治療經驗.中華整形外科雜志,2011,27(6):405-410.
11. 劉毅,張緒生,張誠,等.褥瘡的臨床分型與手術治療原則.中國修復重建外科雜志,2007,21(9):932-936.
12. Kuroda S,Akimoto M.Finite element analysis of undermining of pressure ulcer with a simple cylinder model.J Nippon Med Sch,2005,72(3):174-178.
13. Singh DJ,Bartlett SP,Low DW,et al.Surgical reconstruction of pediatric pressure sores:long-term outcome.Plast Reconstr Surg,2002,109(1):265-269.
14. He J,Xu H,Wang T,et al.Treatment of complex ischial pressure sores with free partial lateral latissimus dorsi musculocutanrous flaps in paraplegic patients.J Plast Reconstr Aesthet Surg,2012,65(5):634-639.
15. Aamer N,Muhammad U,Sakhi J.Prevalence of bed sores among spinal cord injured patients of Muzzafarahad and Bagh,Azad Jammu Kashmir.J Public Health and Biological Sciences,2012,1(1):19-22.

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Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF 17 PATIENTS WITH PRESSURE SORE OF SINUS TYPE

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