Text, photos/Yangcheng Evening News all-media reporter Chen Hui correspondent Li Mei (except signature)
Decubitus is a nightmare for many long-term bedridden patients, especially when encountering intractable bedsores And the family is nothing short of a nightmare. The 55-year-old Mr. Yao suffered such a misfortune. He was bedridden after the operation, resulting in a pressure sore wound of about 10 × 8 cm on the sacrococcygeal region, which was not cured for a long time, and his bones were exposed. Guangzhou Heping Orthopaedic Hospital used skin flaps in trauma microsurgery to help Mr. Yao heal smoothly.
Long-term bedridden patients are prone to pressure ulcers Image/Visual China
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Mr. Yao, 55 years old, suffered a fractured lumbar spine more than ten years ago. 3 months ago, he underwent tumor resection and peroneal myocutaneous flap transfer repair due to right mandibular gingival cancer. He was bedridden for about a week after the operation and developed a pressure ulcer on the buttocks. The treatments in many hospitals were only debridement, dressing change, and VSD negative pressure drainage. , Because the pressure ulcer is close to the anus, the size of the incontinence will stimulate the contamination of the wound surface and cause infection. Later, a colostomy was performed. Because the pressure ulcers are getting bigger and longer, Mr. Yao’s life is miserable.
On February 7, Mr. Yao was taken by his family to the fourth area of trauma microsurgery in Guangzhou Heping Orthopaedic Hospital for treatment.
After a comprehensive evaluation by the department, the decision to treat with flap transplantation was made
“At the time of admission, Mr. Yao was unable to walk and was in low spirits. There was a pressure ulcer of about 10×8 cm on the sacrococcygeal region. Layers of tissue are missing, muscles and bones are exposed, there is an unpleasant rotten odor, and the surrounding skin is red and swollen.” Luo Fayong, a physician from the Fourth District of Trauma Microsurgery, said that Mr. Yao’s pressure ulcer has reached the fourth stage, and conservative treatment is difficult to heal. In healthy patients, surgery is recommended.
Although Mr. Yao has diabetes and high blood pressure, he is usually well controlled. Director Lan Rongyu of the fourth district led the department team to conduct a comprehensive evaluation for Mr. Yao, and believed that his physical condition could tolerate the operation, and formulated a treatment plan for thorough debridement and then flap transplantation.
“The sacrococcygeal area is the position of pressure, and the graft with blood vessels is used for transplantation, which not only has abundant blood supply and strong anti-infection ability, but also has a large amount of tissue, which can fill the dead space and satisfy the skin coverage at the same time. Afterwards, it can withstand pressure, wear resistance, and is not easy to recur. If skin grafting is used, the wound skin after healing is thinner, cannot withstand pressure, and is easy to recur.” Luo Fayong said.
Successful flap transplantation, careful nursing, recovery and discharge from hospital
With the consent of Mr. Yao and his family, the treatment plan was successfully implemented. The first step is to thoroughly debride the wound. After removing the necrotic and degenerated tissue around the wound, the team of doctors in the department fills the affected area with antibiotic bone cement to prevent infection, promote the growth of granulation tissue, and lay a solid foundation for the next flap transplantation.
On February 26, Luo Fayong and his team members carefully performed the flap transplantation for Mr. Yao. They took an island flap from the right buttock near the wound and rotated to cover the wound of the sacrococcygeal defect, and transferred the flap locally to repair the flap. With skilled microsurgery techniques, the operation was successfully completed in only 2 hours.
After the operation, the medical team gave Mr. Yao active wound dressing, anti-infection, blood circulation and other symptomatic supportive treatments and meticulous care, and Mr. Yao recovered well. After 10 days, the color of the transplanted skin flap was ruddy, the skin temperature was normal, and no obvious inflammatory reaction was found. Mr. Yao’s spirit has also improved greatly. Not only can he go to the ground on his own, but he also has a smile on his face. This makes his family very happy.
Mr. Yao sent a pennant to the medical staff (picture provided by the interviewee)
Four preventions Avoiding pressure is the key.
Pressure ulcers, also known as pressure ulcers and bedsores, are mainly due to long-term pressure on local tissues, resulting in tissue ulceration and necrosis due to persistent ischemia, hypoxia, and malnutrition.
Pressure ulcer treatment takes a long time, is difficult and expensive. Severe pressure ulcers are often unhealed for a long time, and are prone to infection, systemic failure, and even life-threatening patients, which seriously affects the patient’s psychology and quality of life. Therefore, the “prevention” of pressure ulcers is particularly important.
1. Change your posture regularly
Change your posture to avoid long-term pressure on the wound, which is the key to preventing pressure ulcers. When lying flat, change every 2 hours. If you are using an alternate air mattress, you can appropriately extend the time for changing postures, once every 4 hours; when sitting upright, change postures every 1 hour, and add 4 to 5 cm thick when sitting in a wheelchair. of sponge pads and lift your body every 15 minutes.
2. Avoid friction and shearing force
When lying flat, raise the head of the bed properly, but not more than 45 degrees, and do not drag, pull, or pull when turning over.
3. Keep the patient’s body and environment clean and dry
Keep the sheets, clothes, etc. flat, clean and dry, wash the patient’s skin with warm water once a day, and if there is urine or feces contamination, feel free to Wash and avoid macerating wounds.
4. Strengthen nutrition