[Clinical and nursing protocol in the treatment of the decubital ulcers]. / Protocollo clinico-assistenziale nel trattamento delle ulcere da decubito.

The decubital ulcers treatment needs a complex clinical approach. The ulcer healing and the absence of recurrences are not only the result of a correct surgical operation. The purpose of this work is to identify all the clinical and nursing parameters that can provide long lasting healing. We treated 105 decubital ulcers in various body areas (sacralis, ischiatic, trochanteric and calcanear regions) and we defined a clinical protocol that starts from prevention, to the admission, till the convalescence. We obtained satisfactory results with few post-operative complications and recurrences. Our protocol is widely confirmed by various authors (the radical toilette, the use of fasciocutaneous and musculocutaneous flaps and the importance of nutrition. In particular, the use of easier flaps (cutaneous, fasciocutaneous), is preferred in the first surgical option to leave other more complex techniques (musculocutaneous flap) for the recurrences treatment. Our protocol follows the patient from the first visit till several months after dismission during convalescence. The pre-operative measures (nutritional state correction, infection care, detersion improvement) as well the post-operating ones (use of circulating fluid beds, rest in bed for at least one month) result to be mandatory for a successful outcome.

Double V-Y advancement flap in the management of lower lip reconstruction.

A new method for lower lip reconstruction is proposed. It is based on a double cutaneous and mucous V-Y advancement flap and is suggested for the surgical treatment of lip cancer confined between the skin and the vermilion with a horizontal spread. Sixteen patients were treated from 1996 to 2001 with this technique and the results were satisfactory both from the functional and the aesthetic standpoints.