[Effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area].

Objective: To investigate the effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area. Methods: From January 2015 to June 2019, 20 patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area were admitted to Department of Burns and Plastic Surgery and Cosmetology of Linyi People's Hospital. Among them, there were 11 males and 9 females, aged 48 to 88 years. The wounds of 13 patients were located in the sacrococcygeal region, and 8 of them had exposed sacrococcyx. The wounds of 4 patients were located in the greater trochanter area of femur, and the wounds of 3 patients were located in the ischial tuberosity area. All the patients had fever in different degree, bacterial infection, hypoproteinemia, and electrolyte imbalance, etc. at admission. After thorough debridement and dressing change, routine negative-pressure wound therapy with negative pressure value of -16.6 kPa was performed according to the scope of lesions in period Ⅰ. When granulation tissue was fresh with less exudate and without residual necrotic tissue, modified double negative-pressure wound therapy in combination with debridement and tension-reduced suture was performed immediately in period Ⅱ. Modified double negative-pressure wound therapy were persistently performed through negative pressure drainage tube inserted into deep part of wounds and negative pressure drainage tube on surface at the same time, with superficial negative pressure value of -19.9 kPa. Meanwhile, systemic anti-infection and nutritional supports were given. The wounds were monitored for the grade of wound healing and whether skin necrosis, split, or fluid accumulation develop at the suture site. The patients were followed up for 1 to 6 months after discharge to monitor wound healing. Length of hospital stay, infection condition before and after the debridement and tension-reduced suture, and complications during treatment were recorded. Results: All wounds achieved first grade healing, with the skin at the suture site healed without split, fluid accumulation, or necrosis. The patients were followed up for 1 to 6 months after discharge, with good shape of surgical incision, little pigmentation on the skin, no hypertrophic scar or contracture, and no recurrence of pressure sores. Length of hospital stay of patients was 24 to 33 d, with an average of 28.5 d. Before debridement and tension-reduced suture, 2 cases were infected with Pseudomonas aeruginosa, 1 case was infected with Escherichia coli and Staphylococcus aureus, and 1 case was infected with Proteus mirabilis. The results of bacterial culture were all negative after debridement and tension-reduced suture. During the treatment, all patients were not complicated with bone or joint infection, necrotizing fasciitis, septicemia, etc. Conclusions: Modified double negative-pressure wound therapy combined with debridement and tension-reduced suture for treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area is easy to operate with minimal injury, easy for patients to accept with a very high level of satisfaction, and is suitable to popularize and applicate for primary hospitals.目的： 探讨改良双负压疗法联合清创减张缝合术治疗骶尾部及周围4期压疮并感染患者的疗效。 方法： 2015年1月—2019年6月，临邑县人民医院烧伤整形美容外科收治20例骶尾部及周围4期压疮并感染患者，其中男11例、女9例，年龄48～88岁，13例患者创面位于骶尾部，其中8例见骶尾骨外露；4例患者创面位于股骨大转子区，3例患者创面位于坐骨结节区。入院时患者均有不同程度发热、细菌感染、低蛋白血症及电解质紊乱等。Ⅰ期根据病变累及范围彻底清创、换药后行常规负压治疗，负压值为-16.6 kPa；待肉芽组织新鲜、渗出少、无坏死组织残留时，立即行Ⅱ期改良双负压疗法联合清创减张缝合术，其中改良双负压疗法为创面深部置入负压引流导管与表层负压引流导管同时实施持续负压吸引，表层负压值为-19.9 kPa。同时予以全身抗感染及营养支持等治疗。观察创面愈合等级，缝合处皮肤有无坏死、裂开或积液，出院后随访1～6个月，观察创面愈合情况，记录患者住院时间、清创减张缝合术前后感染情况、治疗过程中有无并发症。 结果： 创面均甲级愈合，缝合处皮肤无裂开或积液、坏死。出院后随访1～6个月，术口外形良好，皮肤少量色素沉着，无瘢痕增生或挛缩，压疮均未复发。本组患者住院时间为24～33 d，平均28.5 d。清创减张缝合术前，2例患者创面感染铜绿假单胞菌、1例患者创面混合感染大肠杆菌与金黄色葡萄球菌、1例患者创面感染奇异变形杆菌；术后再次行细菌学培养，结果均呈阴性。治疗期间患者均未并发骨或关节感染、坏死性筋膜炎、败血症等。 结论： 改良双负压疗法联合清创减张缝合术治疗骶尾部及周围4期压疮并感染患者，操作简单、创伤小、患者易于接受且对效果满意度较高，适合基层医院推广应用。.