• 동의생리병리학회지
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• 제36권1호
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• pp.35-39
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• 2022

The purpose of this study is to report the effect of Jaungo and acupuncture and debridement for severe pressure ulcer in the elderly. Two Elderly patients with stage 4 pressure ulcer in the sacral region were eligible to participate in this study. Dressing using Jaungo was applied twice a day, and acupuncture was applied 4 times a week along the boundary between the normal epidermis and the pressure ulcer granulation tissue in contact with the pressure ulcer interface. Debridement was performed after partial or total removal, if necessary, under the judgment of the attending physician.In both cases, stage 4 pressure sores in the sacrum covered with crusts were cured in 193 days and 223 days, respectively, and no side effects were reported during treatment. This study shows that Jaungo and acupuncture and debridement may represent effective to treat pressure ulcer. but further studies are needed.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.608-610
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• 2022

In this article, we reported a single case of ischemic fasciitis in a young woman with a progressive immobilization due to a multifocal demyelinating disease of central nervous system, which appeared on an extensive pressure ulcer of the sacral region treated with 10 days of negative-pressure wound therapy (NPWT). Wound examination revealed a significant nontender brown neoformation (9 cm in length × 10 cm in width × 7 cm in height), fixed to the sacrum, presenting hard consistency, and grown in the central portion of the sacral pressure sore. The histologic examination showed central fibrinoid necrosis, and vascular and atypical fibroblastic proliferations, and a diagnosis of ischemic fasciitis was made. Ischemic fasciitis is a rare benign proliferation of atypical fibroblasts that occurs in physically weak patients with reduced mobility. In the literature, the relationship between the use of NPWT on pressure ulcers and the development of ischemic fasciitis is, to the best of our knowledge, not described yet.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.418-424
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• 2018

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.25-28
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• 2014

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.520-523
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• 2007

Purpose: Verrucous carcinoma is a rare, low-grade and well-differentiated squamous cell carcinoma, representing as a warty tumor. Estimation of the incidence for cutaneous lesions is not available because they are rare. We describe a case of verrucous carcinoma, a rare type, complication of a chronic pressure ulcer of duration more than 15 years. Methods: A 17-year-old boy presented with a large lesion involving the sacral area, which had been neglected for about 15 years. He had a history of surgical extirpation 2 years ago, but not cured. Examination revealed a cauliflower-like mass arising from an irregularly oval-shaped tumor which was $6.0{\times}4.5cm$ in size with signs of infection and ulcer. The lesion involved the sacrococcygeal area, spreading to both medial gluteal regions. The perianal skin did not appear to be directly affected. Results: A preoperative punch biopsy revealed a extremely well differentiated verrucous carcinoma. There were positive results in immunohistochemistry in the items of p53, p63, Ki-67. An 'en-bloc' excision of the tumor with the clinically normal surrounding tissue was carried out. Reconstruction was achieved by local regional flap. Histopathological findings of the excised area fully confirmed the preoperative biopsy report. It remained free of recurrence for a period of about 8 months. Conclusion: We believe that in patients with buttock involvement, regardless of the extent of such tumors, surgical therapy should be considered as the first-choice of treatment as reconstruction can be performed without excessive impairment for the patient.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.275-284
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• 2022

Background Population aging has led to an increased incidence of pressure ulcers, resulting in a social burden and economic costs. We developed a three-dimensional knitted fabric (3-DKF) with a pressure-reducing function that can be applied topically in the early stages of pressure ulcers to prevent progression. Methods We evaluated the effects of the 3-DKF in a streptozotocin-induced diabetes mellitus pressure ulcer mouse model, and the fabric was preliminarily applied to patients. Twelve-week-old male C57BL/6 mice were used for the animal experiments. In the pressure ulcer mouse model, an ischemia-reperfusion injury was created using a magnet on the dorsa of the mice. Pressure was measured with BodiTrak before and after applying the 3-DKF to 14 patients at risk of sacral pressure ulcers. Results In the 3-DKF-applied mice group, the ulcers were shallower and smaller than those in the control group. Compared with the mice in the control group, the 3-DKF group had lower platelet-derived growth factor-α and neutrophil elastase expression, as parameters related to inflammation, and increased levels of transforming growth factor (TGF)-β1, TGF-β3, proliferating cell nuclear antigen, and α-smooth muscle actin, which are related to growth factors and proliferation. Additionally, typical normal tissue staining patterns were observed in the 3-DKF group. In the preliminary clinical analysis, the average skin pressure was 26.2 mm Hg before applying the 3-DKF, but it decreased to an average of 23.4 mm Hg after 3-DKF application. Conclusion This study demonstrated that the newly developed 3-DKF was effective in preventing pressure ulcers through testing in a pressure ulcer animal model and preliminary clinical application.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.586-589
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• 2016

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.589-596
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• 2013

Background The treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD) and silver zinc sulfadiazine cream (AgZnSD) with regard to wound healing and cost-effectiveness Methods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospective, randomized controlled trial. The patients were randomized to receive one of the two dressings for an eight-week period. The criteria of efficacy were based on the Pressure Ulcer Scale for Healing (PUSH) scoring tool. The cost of treatment was also assessed. Results Twenty patients (12 women and 8 men) were randomly assigned to receive either AlSD (n=10) or AgZnSD cream (n=10). The demographic data and wound characteristics were comparable in the two groups. The two groups showed no significant difference in the reduction of PUSH score, wound size, or volume of exudate. The tissue type score was significantly lower in the AlSD group ($3.15{\pm}0.68-1.85{\pm}0.68$ vs. $2.73{\pm}0.79-2.2{\pm}0.41$; P=0.015). The cost of treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively; P<0.0001). Conclusions Alginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

• Archives of Plastic Surgery
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• 제41권2호
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• pp.133-139
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• 2014

Background Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. Methods Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. Results According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. Conclusions The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

• 대한물리치료과학회지
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• 제3권2호
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• pp.1011-1019
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• 1996

The incidence of spinal cord injury increase due to traffic accident, industrial accident and leisure sports. Spinal cord injury damages motor and sensory function below the injury level, also affects autonomic functions associated with voiding and defecation. Sexual dysfunction and psychosocial, vocational maladaptations are also some of the unwanted consequences of injury. The purpose of this study is look for means to prevent and to manage complications in spinal cord injury through investigation and analysis. The subjects of this study in spinal cord injured patients were admitted to the department of physical therapy, Kwangju christian Hospital, Nam Kwang Hospital, Chun Nam university Hospital and Cho Sun university Hospital, from April, 1, 1995 to March, 31, 1996. The results are as follows: 1. The subjects comprised 96 cases of spinal cord injury, ranging from 17 to 85(mean-40.8 yrs) and included 72 males and 24 females. Among these patients, 58 were cervical injury, 20 were thoracic injury and 18 were lumbar injury. 2. As for a major causative of spinal cord injury were traffic accident(59.4%), fall down (27.1 %), and motocycle(4.2%).. 3. The bladder control were taken by indwelling cathetar(41.7%), Crede maneuver(37.5%) and self voiding(16.7%). The bowel control were taken by all aid(61.5%), assitance(32.3%) and self defecation(6.2%). 4. Possible of sexual function were 35 cases (47.9%). 5. The device of transfer used wheel chair(69.8%) and bed(16.7%). 6. The patients with higher cord lesion got more serious pain than lower cord lesion. Also the patients with higher cord lesion got a serious spasticity. 7. The incidence of decubitus ulcer among 96 patients were in case 46(47.9%). The largest group of the pressure sore sites were sacral portion(82.0%), less than 1 month of onset occured a large numbers(50%). Incidence of pressure sore by spasticity occured many patients in case of mild or moderate. Incidence of pressure sore by pain occured many patients in case of severe pain.