Our Clinical Experiences in Pressure Sore in a period of 10 years

Abstract

Background: Pressure sores are very big challenging wounds that affect patient, patient's family and surgeon. The incidance of this clinical problem couldn't be decreased by current modern medical methods, even though its occurrence and recurrence could be prevented easily. Material, Methods and Results: We reviwed the patients referred because of pressure sores from August 1995 to November 2005, at the Department of Plastic and Reconstructive Surgery, İnönü University. They have been rewieved and compared in literature with respect to risk factors, localization of wounds, treatment procedures, and complications. In this study, 123 pressure sores of 72 patients were evaluated; 48 of them men and 24 women. The mean age was 43 years (ranging from newborn to 85 years old. 19 pressure sores were treated conservatively and 104 surgically. Conclusion: The most important point of pressure sores is the prevention of the occurence of the pressure sores. The financial and medical cost of pressure sores causing this important and difficult problem, could be minimalized. Key words: Pressure sore, Surgical and conservative treatment, Rehabilitation.

Keywords

• Pressure sore, Surgical and conservative treatment, Rehabilitation.

Bası Yaralı Vakalardaki On Yıllık Klinik Deneyimlerimiz

Öz

Giriş: Bası-yatak yaraları hasta, hasta yakını ve hekim açısından büyük sıkıntı oluşturan yaralardır. Oluşması ve nüks etmesi, basit yöntemlerle önlenebilmesine rağmen modern tıp sık karşılaşılan bu klinik problemin insidansında önemli ölçüde bir azalma sağlayamamıştır. Gereç, Yöntem ve Bulgular: İnönü Üniversitesi Turgut Özal Tıp Merkezi'nde Plastik ve Rekonstrüktif Cerrahi Anabilim Dalı'na Ağustos 1995 ile Kasım 2005 tarihleri arasında bası yarası nedeniyle başvuran vakalar incelendi. Vakalar; bulunan risk faktörleri, lokalizasyonları, tedavi yöntemleri ile ortaya çıkan komplikasyonlar açısından değerlendirildi. Bu çalışmada, 72 hastada toplam 123 bası yarası değerlendirilmiş olup, vakaların 48'i erkek, 24'ü ise bayan hasta idi. Değerlendirilmeye alınan hastaların en küçüğü 23 günlük erkek yeni doğan bebek, en yaşlısı ise 85 yaşında erkek olup, yaş ortalaması 43 idi. 123 bası yarasından 19'u konservatif yöntemlerle tedavi edilirken, 104'üne ise cerrahi tedavi uygulandı. Sonuç: Bası yaralarında en önemli nokta; bası yarası oluşumunun önlenmesi olup, böylelikle tedavisi güç olan bu önemli cerrahi sorunun getireceği finansal ve medikal maliyet en aza çekilebilir. Anahtar kelimeler: Bası yarası, Cerrahi ve konservatif tedavi, Rehabilitasyon.

Anahtar Kelimeler

• Bası yarası, Cerrahi ve konservatif tedavi, Rehabilitasyon.

Kaynakça

1. Akbaş H, Uysal A. Bası Yaralı Olgularda Tedavi Yaklaşımlarımız ve Sonuçlarımız. Türk Plast Rekonstr Est Cer Derg 2001; 9(2): 106-10.
2. Mancoll JS, Phillips LG. Pessure sores. In: Achauer BM, Eriksson E, (ed) Plastic Surgery, St Louis, Missouri, Mosby. 2000: 447-62.
3. Stal S, Serure A, Donovan W, et al. The perioperative management of the patient with pressure sores, Ann Plast Surg 1983; 11(4): 347-56.
4. Barczak C, Barnett R, Childs E, et al. Fourth National Pressure Ulcer Prevalance Survey. Adv Wound Care 1997; 10(4): 18-26.
5. Meehan M. National Pressure Ulcer Prevalence Survey. Adv Wound Care 1994; 7(3): 30, 34, 36-8.
6. Bergstrom N, Demuth PJ, Braden BJ. A clinical trial of the Braden scale for predicting pressure sore risk. Nurs Clin North Am 1987; 22(2): 417-28.
7. Nola GT, Vistness LM. Differential response of skin and muscle in the experimental production of pressure sore. Plast Reconst Surg 1980; 66(5): 728-33.
8. Oot-BA. Pressure ulcer. Prevalance, incidence and associated risk factors in the community. Adv Wound Care 1993; 6(5): 24-9.

9. Richardson RR, Meyer PR. Prevalence and incidence of pressure sores in acute spinal cord injuries. Paraplegia 1981; 19(4): 235-7.
10. Foster RD, Anthony JP, Mathess SJ, Hoffman WY, Young D, Eshima I.Flap selection as a determinant of success in pressure sore coverage. Arch Surg 1997; (8): 868-73.
11. Marschall MA, Mimis Cohen. Pressure sores, (In) Mimis Cohen, (ed) Mastery of Plastic and Reconstructive Surgery, Boston, Little, Brown and Company. 1994, 1371
12. Cervo FA, Cruz AC, Posillico JA. Pressure ulcers. Analysis of guidelines for treatment and management. Geriatrics 2000; 55(3): 55-60.
13. Thomas DR. İssues and Dilemmas in the Prevention and Treatment of Presure Ulcers: A Review. Journals of Gerontology. Serias A, Biological Sciences and Medical Sciences. 2001; 56(6): 328-40.
14. Songür E: Ayın Kitabı, Bası yaraları. Ege Üniversitesi Basımevi. 1998; 86, 70-9.
15. Kato H, Inoue T, Torii S. A new postoperative management scheme for preventing sacral pressure sore in patients with spinal cord injuries. Ann Plast Surg 1998; 40(1): 43.
16. Relander M , Palmer B. Recurrence of surgically treated pressure sores. Scand J Plast Reconstr Surg Hand Surg 1988; 22(1): 89-92.
17. Yamamoto Y, Ohura T, Shintomi Y et al. Superiority of the fasciocutaneous flap in reconstruction of sacral pressure sores. Ann Plast Surg 1993; 30(2): 116-21.
18. Park C, Park BY. Fasciocutaneous V-Y advencement flap for repair of sacral defects. Ann Plast Surg 1988; 21(1): 23-6.
19. Rubayi S, Doyle BS. The gluteus maximus muscle-splitting myocutaneous flap for treatment of sacral and coccygeal pressure ulcers. Plast Reconstr Surg 1995; 96(6): 71.
20. Ohjimi H, Ogata K, Setsu Y, et al. Modification of the gluteus maximus V-Y advencement flap for sacral ulcers: The gluteal fasciocutaneous flap method. Plast Reconstr Surg 1996; 98(7): 1247-52.
21. Yamamoto Y, Tsutsumida A, Murazumi M, et al. Long term outcome of pressure sores treated with flap coverage. Plast Reconstr Surg 1997; 100(5): 1212-7.
22. Wechselberger G, Schoeller T, Otto A. Principles in the operative treatment of pressure sores. Arch Surg 1998; 133(4): 465.
23. Dirnberger F. The nontypical gluteus maximus flap. Plast Reconstr Surg 1988; 81(4): 78.
24. Nahai F, Silverton JS, Hill HL, et al. The tensor fasciae latae musculocutaneous flap. Ann Plast Surg 1978; 1(4): 372-9.
25. Erçöçen AR. Island V-Y Tensor Fasciae Latae Fasciocutaneous Flap for coverage of trochanteric pressure sores. Plast Reconstr Surg 1998; 102(5): 1524-31.
26. Foster RD, Anthony JP, Mathess SJ, et al. Ischial pressure sore coverage: a rationale for flap selection. Br J Plast Surg 1997; 50(5): 374-9.