Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture / 中华创伤杂志

ABSTRACT

Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture.Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017.There were 10 males and five females,aged 40-78 years,with an average age of 68 years.The pressure ulcer ranged from 3 cm× 3 cm to 15 cm × 11 cm.The pressure ulcers were distributed at sacrococcygeal region in eight patients,macro-rotator in four,and ischial nodules in three.According to the size and position of pressure ulcer,different musculocutaneous flaps were selected,and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound.After the operation,the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing.The stitches were removed after the wound healed.The wound healing,pressure ulcer recurrence,flap texture,flap color,and donor site were observed,and patient satisfaction were also surveyed.Results All patients were followed up for 12-36 months,average 24 months.The pressure ulcer was healed in 12 patients after the first repair operation.In two nonunion cases,the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint,causing strong resistance during limb movement and strong flexor reflex.Two patients were healed after twice operation.In one patient,the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation,and the wound was healed after twice operation.All muscle flaps covered the wound and survived well,and the wounds were completely closed and healed with good shape,texture as well as elastic recovery.After the suture was removed18 days after surgery,the patients were discharged satisfactorily.The patients received conventional pressure ulcer care,and no new pressure ulcer was reported during the follow-up.The flap donor site was healed well after autologous skin repair.Conclusion For pressure ulcer in patients of ankylosing posture,flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate.