Objective To systematically evaluate the effectiveness and safety of Resina Draconis for pressure ulcer. Methods Such databases as The Cochrane Library (Issue 4, 2013), PubMed, Elsevier SDOL, Web of Knowledge, CBM, CNKI, VIP and WanFang Data were searched from inception to May 2013 to collect randomized controlled trials (RCTs) about Resina Draconis for pressure ulcer. Two reviewers were assigned to independently screen the literature according to inclusion and exclusion criteria, extract data, and appraise the methodological quality. Then, meta-analysis was conducted using RevMan 5.2.4 software. Results A total of 14 RCTs were included, involving 610 patients. The results of meta-analysis showed that, Resina Draconis treatment were associated with a higher effective rate for pressure ulcer (RR=1.17, 95%CI 1.08 to 1.26, Plt;0.000 1). The results of descriptive analysis showed that, compared with the control group, Resina Draconis treatment shortened healing time. As for safety, adverse reactions had not been reported. Conclusion Resina Draconis can improve the effective rate for pressure ulcer and shorten the healing time, compared with other drug treatments. However, due to limited quality and quantity of the included studies, this conclusion needs to be proved by more high quality studies.
Objective To seek evidence based methods to treat bedsore of aged patients. Methods We raised clinical questions according to the condition of an eighty-year old male patient, and then, with "bedsore" (treatment or prevention) as key words we searched evidences from Cochrane Library (2nd edition 2002), Medline (1996-2002.4), and Sumsearch. Results We found 3 SR (systematic review) from Cochrane Library, 3 Meta-analyse and 38 RCT (randomized controlled trial) from medline, and 3 SR and 9 RCT from Sumsearch. Conclusion 1 Various types of mattress are useful in prevention the bedsore. 2 There is still not enough evidences of electromagnetic therapy. 3 In state II bedsore, healing is faster in using collagen Dressing than using water-glue Dressing. 4 Local application of antibiotics and Phenytoin sodium can accelerate the growth of new granulation tissue. 5 Nutritional support is necessary for bedsore prevention and healing. According to these evidence, we make the best care plan for this patient. After our treatment, the wound healed 10 days later, and he doesn’t occur bedsore any more.
【Abstract】 Objective To investigate the method and effectiveness of repairing sacrococcygeal pressure sores with modified upper gluteal rhomboid fasciocutaneous flap. Methods Between January 2004 and March 2011, 43 patients with sacrococcygeal pressure sores were treated. There were 25 males and 18 females with an average age of 63 years (range, 38-95 years). The disease duration was 3 months to 2 years and 6 months (mean, 8.5 months). The size of pressure sores ranged from 6 cm × 5 cm to 18 cm × 13 cm. According to the extent and lesion degree of pressure scores, 23 pressure sores were rated as degree III and 20 pressure sores as degree IV. The modified upper gluteal rhomboid flap was designed, one-side upper gluteal fasciocutaneous flaps were transplanted to repair sacrococcygeal pressure sores in 19 cases and two-side flaps in 24 cases. The size of one side flap ranged from 6.5 cm × 4.5 cm to 18.0 cm × 11.5 cm. Results Fluid under flap occurred in 1 case and edge necrosis of the flaps in 3 cases at 7 days after operation, which were cured after drainage and dressing change; the other flaps survived, and incisions healed by first intention. All patients were followed up 6 months to 3 years with an average of 11 months. Two patients relapsed at 5 months and 8 months, respectively; the other patients had no recurrence. The color of the flaps was normal, and the appearance and elasticity of the flaps were good. Conclusion The modified upper gluteal rhomboid fasciocutaneous flap has the advantages of simple design and operation, less injury, and reliable effect in repairing sacrococcygeal pressure sores.
Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel(NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm × 6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.
Objective To investigate the clinical typing and their relevant surgical treatment principle and method of pressure sore. Methods From January 1983 to April 2006, 122 patients with 179 pressure sores were treated. There were 93 males and29 females, aging 1568 years. The pressure sores were located at sacrococcygeus (54 lesions), petrochanteric region (37 lesions), ischial tuberosity (30 lesions), heel (17 lesions), olecranon (15 lesions), scapula (9 lesions), lateral malleolar (7 lesions), caput fibulace (4 lesions), pretibial (3 lesions), and lumbar region (3 lesims)respectivly. The disease course was from 2 months to 11 years. The areas of pressure sores were from 1.5 cm× 1.0 cm to 20.0 cm×18.0 cm. According to the wound characteristics, the pressure sores were divided into three types：sinus type（12/179）, ulcer type （74/179） and mixed type（93/179）.Aimed at different types of pressure sore, skin grafting, skin flap and myocutaneous flap were employed to repair wound. The areas of flaps were from 5.0 cm×3.5 cm to 26.0 cm×14.5 cm. The areas of skin grafting were from 7 cm×5 cm to 23 cm×12 cm. Results All wounds of sinus type healed by firstintention except one; and all flaps survived. All wounds of uler type healed byfirst intention; and the flaps survived completely except two which had a partial necrosis. All flaps which harvested to repair 93 pressure sores of mixed typewere survived. But one or two sinus occurred in 8 cases. Two healed by operation, and the others healed by dressing exchange. The wounds healed by first intention. The donor sites healed by first intention. The routine followup in 73 patients after 6 months showed that the recurrence appeared in 4 mixed type. The recurrence rate was 55% and the other patients had good outcome. Conclusion Clinical typing of pressure sore is helpful to select the suitable operation method and improve the rate of success.