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.	张春雷,张春阳,张建平,等.臀大肌肌皮瓣联合真皮皮瓣修复骶尾部褥疮.中国修复重建外科杂志,2011,25(6):763-764.
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3.	戴亚琴,贾勤,朱红英,等.30例双侧臀大肌肌皮瓣修复骶尾部巨大压疮的护理.护理学报,2013,20(2B):67-69.
4.	侍德.骨科修复重建手术学.上海:复旦大学出版社,2001:143-144.
5.	顾莺,张玉侠,沈国妹,等.40例儿科病人院内枕部压疮发生的回顾性分析.中国护理研究,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.	李强,海恒林,李华涛,等.股外侧斧头形筋膜皮瓣修复双侧股骨大转子部压疮11例.中华烧伤杂志,2013,29(4):397-399.
9.	张卫红,朱旭.联合治疗Ⅳ度褥疮创面的临床体会.中华显微外科杂志,2009,32(4):332-333.
10.	许喜生,马铮铮,周永生,等.重度褥疮的临床治疗经验.中华整形外科杂志,2011,27(6):405-410.
11.	刘毅,张绪生,张诚,等.褥疮的临床分型与手术治疗原则.中国修复重建外科杂志,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. 张春雷,张春阳,张建平,等.臀大肌肌皮瓣联合真皮皮瓣修复骶尾部褥疮.中国修复重建外科杂志,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. 戴亚琴,贾勤,朱红英,等.30例双侧臀大肌肌皮瓣修复骶尾部巨大压疮的护理.护理学报,2013,20(2B):67-69.
4. 侍德.骨科修复重建手术学.上海:复旦大学出版社,2001:143-144.
5. 顾莺,张玉侠,沈国妹,等.40例儿科病人院内枕部压疮发生的回顾性分析.中国护理研究,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. 李强,海恒林,李华涛,等.股外侧斧头形筋膜皮瓣修复双侧股骨大转子部压疮11例.中华烧伤杂志,2013,29(4):397-399.
9. 张卫红,朱旭.联合治疗Ⅳ度褥疮创面的临床体会.中华显微外科杂志,2009,32(4):332-333.
10. 许喜生,马铮铮,周永生,等.重度褥疮的临床治疗经验.中华整形外科杂志,2011,27(6):405-410.
11. 刘毅,张绪生,张诚,等.褥疮的临床分型与手术治疗原则.中国修复重建外科杂志,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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