Ulus Travma Acil Cerrahi Derg. 2006; 12(2): 143-149

Basý yarasý olan hastalara uyguladýðýmýz cerrahi tedavi yöntemleri ve sonuçlarý

Ufuk Bilkay, Evren Helvacý, Cenk Tokat, Cüneyt Özek, Yalçýn Akýn
Ege Üniversitesi Týp Fakültesi Plastik ve Rekonstrüktif Cerrahi Anabilim Dalý, Ýzmir.

AMAÇ: Evre 3 ve evre 4 basý yaralarý nedeniyle ameliyat edilen hastalarda uygulanan cerrahi tedavi yöntemleri ve sonuçlarý retrospektif olarak deðerlendirildi.
GEREÇ-YÖNTEM: 1984-2002 tarihleri arasýnda toplam 66 hastada (45 erkek, 21 kadýn; ortalama yaþ 39.4; daðýlým 13-80) 100 basý yarasý, fasyokütan flep, muskülokütan flep, kýsmi kalýnlýkta deri greftlemesi ve primer onarým teknikleriyle tedavi edildi.
BULGULAR: Altmýþ altý hastanýn 40’ý (%61) paraplejik, 5’i (%7) kuadriplejik, 9’u (%14) uzun süredir yataða baðýmlý ve 5’i (%7) debilizan hasta, 7’si (%11) ise multipl skleroz ve spina bifida hastasý idi. Ameliyat sonrasý uzun süreli izlemde hastalarýn %24’ünde (16/66) ve tedavi edilen basý yaralarýnýn %22’sinde (22/100) nüks saptandý. Nükslerin %23’ü (10/43) iskiyon, %21’i (8/37) sakrum ve %20’si (4/20) trokanter bölgesinde idi; %42’si eksizyon ve primer onarým, %17’si (6/34), fasyokütan flep cerrahisi ve %12’si (5/39) müskülokütan flep cerrahisi yöntemi sonrasýnda meydana geldi.
SONUÇ: Greftleme ve primer onarým gibi yöntemlerde nüks oranlarýnýn daha yüksek olduðu, fasyokütan veya muskülokütan fleplerin tedavide kullanýmýyla bu nüks oranlarýnýn belirgin düzeyde azaltýldýðý belirledik.

Anahtar Kelimeler: Kalça/anatomi/histoloji, kalça/cerrahi; hareket; nekroz/etyoloji/cerrahi; basý yarasý/cerrahi; cerrahi flepler

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Surgical coverage technics of pressure sores and their outcomes

Ufuk Bilkay, Evren Helvacý, Cenk Tokat, Cüneyt Özek, Yalçýn Akýn
Department of Plastic and Reconstructive Surgery, Medicine Faculty of Ege University, Ýzmir, Turkey.

BACKGROUND: We reviewed the outcome of 66 patients with 100 pressure sores between 1984 and 2002.
METHODS: In the current study, 100 pressure sores in 66 patients (45 male, 21 female; mean age 39.4; range 13 to 80 years) who underwent surgical repair of presure sores reconstructed using myocutaneous or fasciocutaneous flaps, skin grafts, excision and closure.
RESULTS: The risk factors for pressure sores included acute trauma-induced spinal cord injury in 40 (61%) patients with paraplegia and in 5 (7%) patients with quadriplegia; congenital spina bifia and multiple sclerosis in 7 (11%) patients and prolonged immobilization in 14 (21 patients) patients. We achieved an overall pressure sore recurrence rate of 22% and overall patient recurrence of 24% in a-3-year follow-up. The recurrence rates according to anatomic sites; 23% (10 of 43) for the ischial pressure sore, sacral 21% (8 of 37), and trochanteric 20% (4 of 20). Fasciocutaneous and myocutaneous flap reconstructions were the most durable, as they were associated with 17% (6 of 34) and 12% recurrence rates (5 of 39).
CONCLUSION: To reduce the recurrance rates the authors advocate the use of myocutaneous and fasciocutaneous flaps instead of skin grafts or direct closure for the coverage of pressure sores.

Keywords: Buttocks/anatomy/histology, buttocks/surgery; movement; necrosis/etiology/surgery; pressure ulcer/surgery; surgical flaps

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