The Treatment of Pressure Sore Using Hydrogel and Hydrocolloid Dressing

Pressure sores are a common complication of hospitalized patients. However, It is often impossible to correct surgically because the general conditions of these patients are poor. It is known that the hydrogel has a powerful autolytic effect by providing moist environments and facilitates wound healing and hydrocolloid dressing is also known to promotes granulation tissue formation and epithelialization. The patients were treated with hydrogel(Purion gel(R), Coloplast A/S, Denmark) and hydrocolloid dressing (Comfeel Plus Transparent Dressing(R), Coloplast A/S, Denmark) after surgical debridement of pressure sores progressed to stage III(n=2) and IV(n=7). This combination treatment could facilitate to debride the nectrotic tissue and promote granulation tissue formation epithelialization simultaneously. We could achieve complete healing of pressure sores using the combination treatment without requiring surgical correction. In conclusion, hydrogel in combination with hydrocolloid dressing is effective in acheiving complete healing of progressed pressure sores.

Treatment of Greater Trochanteric Sore by using Distal Folded Tensor Fascia Lata Myocutaneous Flap

Tensor fascia lata myocutaneous flap is the most useful local flap in surgical treatment of greater trochanteric sore. But the small volume of muscle included in Tensor fascia lata myocutaneous flap makes the thickness of flap thinner and the rate of recurrence higher than any other muscle flap. To overcome this disadvantage, Scheflan(1981) used distal folded Tensor fascia lata myocutaneous flap in treating greater trochanteric sore. But Scheflan used this flap as an island flap, that made the blood supply unstable and unreliable, and required skillful technique. And he didn`t use distal part of the thigh which made the efficacy of flap bulk small. In order to thicken the flap bulk, we used the distal folded tensor fascia lata myocutaneous flap. We have treated 10 patients by using newly designed distal folded tensor fascia lata myocutaneous flap. All of them had previous systemic disease. Some had general paresthesia and others had heart failure, diabetic mellitus, neuralgia and so on. We drew V-shaped design, one wing was from the anterior superior iliac spine to the lateral condyle of the femur and the other wing was from the center of the greater trochanter to the lateral condyle of the femur. After design, we harvest the flap and fold the flap two or three times. Flap bulk is enough to prevent sore recurrence. We follow up the patients from 6 months to 35 months. No recurrence is occurred. Our newly designed flap has sufficient volume and reliable blood supply. The result is good and satisfactory.

Treatment of Greater Trochanteric Sore by using Distal Folded Tensor Fascia Lata Myocutaneous Flap

Tensor fascia lata myocutaneous flap is the most useful local flap in surgical treatment of greater trochanteric sore. But the small volume of muscle included in Tensor fascia lata myocutaneous flap makes the thickness of flap thinner and the rate of recurrence higher than any other muscle flap. To overcome this disadvantage, Scheflan(1981) used distal folded Tensor fascia lata myocutaneous flap in treating greater trochanteric sore. But Scheflan used this flap as an island flap, that made the blood supply unstable and unreliable, and required skillful technique. And he didn`t use distal part of the thigh which made the efficacy of flap bulk small. In order to thicken the flap bulk, we used the distal folded tensor fascia lata myocutaneous flap. We have treated 10 patients by using newly designed distal folded tensor fascia lata myocutaneous flap. All of them had previous systemic disease. Some had general paresthesia and others had heart failure, diabetic mellitus, neuralgia and so on. We drew V-shaped design, one wing was from the anterior superior iliac spine to the lateral condyle of the femur and the other wing was from the center of the greater trochanter to the lateral condyle of the femur. After design, we harvest the flap and fold the flap two or three times. Flap bulk is enough to prevent sore recurrence. We follow up the patients from 6 months to 35 months. No recurrence is occurred. Our newly designed flap has sufficient volume and reliable blood supply. The result is good and satisfactory.

The Simple Bilateral Gluteus Maximus Myocutaneous Advancement Flap for Coverage of Sacrococcygeal Pressure Sore: Refinements and Introduction of "Bomb-Shape" Design

The sacral area is the most frequent site of pressure sore. Because bony prominence is broad and flat along with little soft tissue padding. Between many muscle flaps, the gluteus maximus myocutaneous flap is the most reliable one for surgery of sacral pressure sores. After complete resection of ulcer, the gluteus maximus muscle detached from its original site including posterior iliac crest. After adequate dissection proceeded and bony prominence removed, flap repair is done at the central line. When performing this flap, most surgeon use elliptical design and incision. In the past, we also used elliptical incision and sometimes experienced some drawbacks especially when wound extended close to anus. There are difficulties on repair of perianal skin, central tension of long vertical scar, perianal skin adhesion and natal cleft distortion and resulting asymmetry of gluteal contour and contamination of operation site by defication. After review of the photographs in the references dealing with pressure sores, we had an impression that there are skin adhesion near the anus in some cases and actually experienced such cases in other surgeon's operations. This time, we applicate new design called the "Bomb-shape" design when performing this flap to patients who have a broad wound extent close to anus or perianal skin. The "Bomb-shape" design is a concept of adding bilateral subcutaneous incisions to lower part of classic elliptical incision and we named as such because it resembles the military bomb in shape. We expect the effect of preserving the perianal skin and preventing the skin adhesion or natal cleft distortion and performed this procedure in 15 patients whose defect close to anus. Consequently, benefits of this method are spreading tension of vertical scar, decreased contamination in wound care, earn skin stability without perianal skin adhesion or natal cleft distortion, so maintain the symmetry of gluteal contour and get better cosmetic result. There is no significant increase in operation time in that no need of handling the "dog-ear", and all 15 patients have good results and are satisfied, so we introduce this flap design carefully with concurrent review of literature.