Decubitis surgery for spinal injury patients

А.Y. PARAY, А.G. BUTYRSKIY, V.N. STAROSEK

State Medical University named after S.I.Georgiyevsky, Simferopol, UKRAINE

The work objective : analyzing the results of operative treatment of decubitis of different localization in the spinal injury patients.

Materials and methods : 51 patients with stable loss of moving functions and decubitis of different localization were operated. 80 surgical operations were performed. The patients were divided to 3 groups according to the decubitis localization and management : I group consisted of patients having decubitis in the region of the ischial tuberosity (25 persons), II group consisted of patients having decubitis in the region of the greater trochanter (14 persons), and III group consisted of patients having decubitis in the sacrococcygeal region (12 persons).

Results. In I group, the ischial tuberosity was resected in 23 persons. wound infections was observed in 2 patients (14.3%) in postoperative period. In II group, the greater trochanter was resected in 10 persons; decubitis closed up by initial intention in 10 persons (71.4%), unsoundness of sutures caused by tension of the wound edge and increased spasticity of muscles was noted in 3 (21.4%) patients, the skin graft necrosis due to the apparent skin rigidity and abnormal bloodstream was observed in 1 person. In III group, the coccygeal bone resection with simultaneous or delayed plastic surgery was applied to 5 patients, and closing up by initial intention was found in 9 patients. In the course of analysis carried out for 2 to 5 years following the operation, good treatment results were found in 49 patients (96%), non-satisfactory result was observed in 2 patients having progressive destruction of caxal bones and recurrent decubitis.

Conclusions: 1. Formation of decubitis is a often complication of the spinal marrow wound dystrophy and takes place in 90% patients. Their occurrence correlates with the spinal disturbance severity and abnormality level. 2. Radical surgical interventions carried out in proper time with regard to decubitis researches enable to achieve stable healing. An indispensable condition of efficacy of operations was opening and effective drainage of purulent leakages, excision of healing tissues, fistulas, hypertrophic synovial bursas, resection of proper bones regardless of their affection by osteomyelitis. 3. In view of the weak tendency towards restriction of the purulent process in the spongy substance of caxal bones, radical operations together with resections of bones, especially, minor ones by functionality such as : ischial bone, coccygeal bone, greater trochanter were preferred. 4. The stable result may be achieved only by removing defect of soft tissues and recovery of trauma-resistant skin integuments in the completion of the operation by different non-free plastic surgery and transposition of a cellulocutaneous or fasciocutaneous pedicle flap of adequate thickness and size.

Date: 2014-12-28; view: 1109