Proximal femoral resection and Tensor Fascia Lata flap for recalcitrant trochanteric pressure ulcers

Application efficacy of bundled nursing management in care of elderly patients with pressure ulcers

OBJECTIVE

To discuss the efficacy of bundled nursing management in nursing of elderly patients with pressure ulcers.

METHODS

148 hospitalized elderly patients with pressure ulcers in our hospital were taken as the study subjects. The study subjects were randomly assigned to the observation group (n=74) and the control group (n=74) using the random number table method. The control group adopted the routine nursing model, while the observation group adopted the bundled nursing. A comparison of the two groups included the cure rate of pressure ulcers, anxiety (using self-rating anxiety scale), depression (using self-rating depression scale), quality of living (using MOS SF-36 scale), sleep quality and patient satisfaction.

RESULTS

The cure rate of pressure ulcers in the observation group was greater than that in the control group (P<0.01). The SAS and SDS scores in the observation group were significantly less than those in the control group (P<0.001). The scores of physical function, general health, social function, emotional role, and mental health in the observation group were greater than those in the control group (all P<0.01). The sleep quality scores in the observation group were less than those in the control group (all P<0.001). The nursing satisfaction in the observation group was greater than that in the control group (P<0.05).

CONCLUSION

The application of bundled nursing management in the nursing of elderly patients with pressure ulcers is effective, which can promote the cure rate of pressure ulcers, improve the depression or anxiety, quality of living and sleep of patients, and enhance patient satisfaction. It deserves clinical promotion and use.

The Role of Myocutaneous Flaps in the Treatment of Patients with Multiple Decubitus Ulcers

The current research aims to present the therapeutic approach in the case of a paraplegic patient hospitalized in the Plastic Surgery Department at the “Bagdasar-Arseni” Emergency Clinical Hospital for the treatment of decubitus ulcers located at the level of the sacral, left trochanteric and posterior thoracic regions. The particularity of the case is given by the complexity of the surgical interventions necessary for the reconstruction of the above-mentioned anatomical regions. In order to cover the sacral region, two gluteal myocutaneous flaps were used, followed by a tensor fascia lata flap for the trochanteric lesion. For the thoracic defect, the surgical team has chosen the technique of excision and direct suture. Following reconstructive surgery, the patient had a favorable local evolution, being included in an intensive medical recovery program within the same health unit.

Bilateral Fascia Lata Flap: An Alternative for Massive Abdominal Wall Defect Repair

The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.