Experience in surgical treatment of bedsores of various localizations

Background. Treatment of pressure sores is one of the intractable tasks of purulent surgery in somatically severe patients with impaired blood circulation in areas subject to prolonged pressure, friction, or tissue shear. Surgical treatment methods depend on the location of the pressure sores and the general condition. At the same time, the percentage of forced disabling operations for bedsores complicated by the infectious process remains high, which also requires further study.

Objective: to substantiate the effectiveness of surgical treatment of pressure sores of various localization.

Materials and methods. The results of surgical treatment of 105 patients with bedsores of various localization aged from 16 to 76 years were studied. Of these, 11.4 % of patients had multiple lesions. About 39.0 % of patients were case had bedsores localized in the sacral region, 25.7 % – in the sciatic region, 14.3 % – in the area of the large trochanter, 3.8 % – in the area of the iliac crest, 2.9 % – in the scapular region, 1.9 % – in heel area, 1.0 % – in the occipital region.

Depending on the phase of the wound healing process, all patients were divided into 2 groups. The first group included 45 (42.9 %) patients with bedsores in the inflamation phase. All of them underwent radical and stage-by-stage surgical debridement of wounds with excision of necrotic tissues, adequate drainage during treatment. After cleansing the wound and the appearance of granulation tissues, 32 (71.1 %) patients were admitted to the second stage of defect closure surgery, the remaining 13 (28.9 %) patients had bedsores closed by secondary tention.

The second group included 60 (57.1 %) patients with bedsores in the second phase of the wound healing process and 32 (30.5 %) patients after the first stage of surgery.

Research results. During treatment, 18 (19.6%) patients underwent surgical treatment and rehabilitation of the wound, followed by secondary sutures or autodermoplasty with a full-layer skin grafts, and 7 patients underwent sciatic bone resection, after which complete healing of bedsores was noted. At the same time, 67 (72.8 %) patients underwent plastic surgery of bedsores with displaced rotational skin-fat flaps, skin-fascial and skin-fascial-muscular rotational flaps on the vascular pedicle.

Conclusion. Surgical treatment of patients with bedsores of various localization, taking into account the phase of the wound healing process, is the most effective and safe method.

Plastic surgery of bedsores of various localization in the II phase of the wound healing process with displaced rotational skin-fat flaps, skin-fascial and skin-fascial-muscular on the vascular pedicle in combination with active wound drainage are the most effective methods.

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