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Clinical application of double imbrication film in closed negative pressure drainage of sacrococcygeal pressure ulcer

Tian Gengjia, Wang Shujuan and Xu Xiaoqin

The clinical results of 15 cases of closed negative pressure drainage (ENPD) for sacrococcygeal pressure sores with the modified laminating method were summarized. Methods ENPD of sacrococcygeal pressure sores was laminated with modified double lamination method. 13 patients achieved good clinical results, and achieved the expected goal. Conclusion: when treating sacral caudal pressure ulcers with ENPD, by modified film sticking method, It can significantly reduce the frequency of lamination shedding, ensure the airtight of lamination, reduce the rate of air leakage, improve the treatment effect of ENPD, shorten the curing time of pressure sore, reduce the workload of medical staff, reduce the pain and economic burden of patients, and promote the early recovery of patients with pressure sore.

Dead space and poor drainage are the main reasons for intractable sacral decubitus ulcers. The objective of this study was to investigate the effects of treatment for sacral decubitus ulcer using space filling through muscle flap and closed irrigation. A total of 22 patients with serious sacral decubitus ulcer were treated with space filling through muscle flap and closed irrigation. After debridement of the decubitus ulcer, the infected areas over the bony prominence and osseous prominences were debrided. We elevated biceps femoris long head or semitendinosus and semimembranosus muscle. Pedicled by proximal part of muscle, the muscle flap was elevated to cover the ischial tuberosity. Transfusion systems of inflow and outflow drainage were placed between the muscle flap and ischial tuberosity. Wound healing and complications were observed. One wound dehiscence healed after secondary suturing. One wound gradually healed by dressing change after 3 weeks. The other cases had good results. Space filling and closed irrigation were complementary. The use of these two methods simultaneously is useful for the management of sacral decubitus ulcers. Sacral pressure ulcers, especially grades III and IV, rarely respond to conservative treatment. The thorough surgical debridement needed to remove necrotic tissues often leaves a large cavity, in addition to the already existing soft-tissue defect. A large cavity will lead to poor drainage, which will increase infection and lead to operation failure. Closed irrigation combined with space filling can effectively obliterate the dead space and produce full drainage. However, there have been no reports concerning the use of these two methods simultaneously for 24 hours. This is a report of the clinical results of the combined method. Clinically, it is exceptionally effective, in a comparatively short time, in wounds that are considered impossible to heal and wounds that are thought to require an extremely long time to heal.

From January 2010 to January 2013, 22 patients with sacral pressure ulcers, 18 of them paraplegic, 4 of them with congenital lower limb hypoplasia, were treated with this technique. Twelve patients were men and 10 were women, and their ages ranged from 14 to 70 years (mean, 42 years).