Improvement of Surgical Outcomes of Deep Pressure Ulcers in the Elderly

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  • 高齢者褥瘡手術における成績向上の工夫

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Abstract

Background:Deep pressure ulcers in Stage Ⅲ or Ⅳ remain intractable despite continuation of conservative treatment for several months or years.
<br>Surgical risk and issues associated with surgery are meaningful concerns; however, less-invasive reconstructive surgery may lead to improved patient quality of life even in the elderly. The author described the latest mode of reconstructive surgery and its perioperative management of pressure ulcer derived from experiential data regarding sacral pressure ulcers.
<br>Objective:To evaluate the effect of flap surgery in elderly patients presenting with sacral pressure ulcers.
<br>Methods:From 1998 to the present, two types of flap surgery were conducted in 125 cases involving sacral pressure ulcers. Outcome was evaluated based on complete healing rates.<br>
Results:Two primary surgical procedures, which transitioned from the pedicled flap to the perforator flap, were performed:pedicled flaps were employed mainly in the “First stage”, whereas perforator flaps were utilized in the “Second stage”. The rate of primary healing, e.g., complete surgical wound healing achieved within three weeks post-operatively, among the three age groups was compared. Differences were not statistically significant; however, healing rates in the elderly displayed relative gain in the “Second stage” group.
<br>Conclusion:A minimally invasive procedure is desirable particularly in the elderly; additionally, perioperative management is mandatory in order to improve the healing rate. Preventive management of pressure ulcers, including general and local management, is also important following surgical intervention.

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