BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical di...BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.展开更多
BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the mo...BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.展开更多
BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Ber...BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.展开更多
Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical managemen...Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management,are available. In flap surgery for pressure sores, a variety of flap types may be used;each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction.Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital.The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap.Postoperative follow-ups and evaluations were performed.Results: The mean age of the study group was 43.7 ± 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases.The mean surface area of sores was 24.8 ± 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ± 0.98 cm and required around 6.8 ± 1.9 weeks to heal.Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.展开更多
Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This r...Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.展开更多
目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual...目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual analogue scale,VAS)、Wexner量表、健康调查简表(the MOS item short from health survey,SF-36)评价疼痛、肛门功能和生活质量比较两组患者治疗后的创面面积、治疗效果、肛门功能、生活质量、切口愈合时间和术后住院时间、术后后遗症。结果与对照组比较,观察组术后7 d、21 d创面面积较小;观察组术后3 d、7 d患者VAS评分、创面分泌物评分、创面肿胀度评分较低,肉芽生长情况评分较高;术后7、28 d Wexner量表评分较低;术后7 d的SF-36评分较高;切口愈合时间较短,组间差异均有统计学意义(P<0.05)。观察组后遗症发生率为5.0%(2/40),低于对照组的22.5%(9/40)(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论接受改良Hanley术联合拖线疗法可减轻坐骨直肠间隙肛周脓肿患者术后创面疼痛,缩短愈合时间,提高术后生活质量,减少后遗症的发生。展开更多
基金Supported by Research fund of Dankook University in 2023,No.R202300627.
文摘BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.
文摘BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.
文摘BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.
文摘Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management,are available. In flap surgery for pressure sores, a variety of flap types may be used;each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction.Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital.The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap.Postoperative follow-ups and evaluations were performed.Results: The mean age of the study group was 43.7 ± 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases.The mean surface area of sores was 24.8 ± 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ± 0.98 cm and required around 6.8 ± 1.9 weeks to heal.Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.
文摘Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.
文摘目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual analogue scale,VAS)、Wexner量表、健康调查简表(the MOS item short from health survey,SF-36)评价疼痛、肛门功能和生活质量比较两组患者治疗后的创面面积、治疗效果、肛门功能、生活质量、切口愈合时间和术后住院时间、术后后遗症。结果与对照组比较,观察组术后7 d、21 d创面面积较小;观察组术后3 d、7 d患者VAS评分、创面分泌物评分、创面肿胀度评分较低,肉芽生长情况评分较高;术后7、28 d Wexner量表评分较低;术后7 d的SF-36评分较高;切口愈合时间较短,组间差异均有统计学意义(P<0.05)。观察组后遗症发生率为5.0%(2/40),低于对照组的22.5%(9/40)(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论接受改良Hanley术联合拖线疗法可减轻坐骨直肠间隙肛周脓肿患者术后创面疼痛,缩短愈合时间,提高术后生活质量,减少后遗症的发生。
