Tóm tắt Luận văn Study of the pedicle superior gluteal artery perforator flaps with vacuum asisted closure therapy for chronic ulcer sacral reconstruction
MINISTRY OF EDUCATION
MINISTRY OF DEFENSE
VIETNAM MILITARY MEDICAL UNIVERSITY
NGUYEN VAN THANH
STUDY OF THE PEDICLE SUPERIOR GLUTEAL
ARTERY PERFORATOR FLAPS WITH VACUUM
ASISTED CLOSURE THERAPY FOR CHRONIC
ULCER SACRAL RECONSTRUCTION
Speciality: BURN
Code: 62720128
SUMMARY OF DOCTORAL THESIS
HA NOI - 2018
THE PROJECT IS COMPLETED IN VIETNAM MILITARY
MEDICAL UNIVERSITY
Science instructor:
Review 1:
Review 1:
Review 1:
The dissertation will be protected before the Board of thesis
dissertation on May 201
The dissertation can be found at:
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National Library
VIETNAM MILITARY MEDICAL UNIVERSITY
LIBRARY
1
QUESTION
Stroke is a common disease that accounts for the high incidence
of various types of injury due to various causes of chronic ulcer.
Stomach abscesses account for 25% of all ulcer sites. Stomach ulcers
are treated in four categories ranging from mild to severe. Grade III
and IV lesions are chronic lesions that are characterized by multiple
nodules, multiple pseudobulst, and foul odor, spread by deep scales
causing osteoarthritis of the same severity that can lead to septicemia
and possibly death. death Chronic ulcers are treated with various
stages of treatment such as necrotic necroinflammation,
inflammatory bone remission, negative pressure vasodilatation
(VAC) Coherence combined with systemic therapy such as
improvement of body condition and treatment of underlying disease.
In the world and in the country there are many research works
(NC) using large buttock skin flap that can be used to cover the ulcer
area of the same amputation due to the blood supply to the rich flap,
thick skin tissue to ensure tissue The cushioning is good for the
crutches in gravity-bearing positions, but there are some drawbacks,
such as possible bleeding in the surgery or aesthetic function in the
buttocks of traumatic patients. . Therefore, over the past two decades,
surgeons around the world have focused on NC to apply transdermal
patches (AP) to the treatment of ulcerative colitis to treat ulcers.
Limitations of previous treatments. In Vietnam, the treatment of
patients with chronic obstructive pulmonary disease is small and
individual, with very few studies on AP anatomy in adults in
Vietnam. In the treatment method, there is no NC scales of AP of the
anesthetic combined with negative pressure to prepare the
2
background. With the desire to contribute to the development of a
safe, effective and most suitable treatment for patients with chronic
obstructive pulmonary disease (grade III, IV), we conducted a study
on: “Study of the pedicle superior gluteal artery perforator flaps
with vacuum asisted closure therapy for chronic ulcer sacral
reconstruction” with the following objectives:
1. Description of anatomy of AP vascular aneurysms.
2. Effectiveness evaluation of skin lesions AP Superior gluteal
Artery Perforater combined with negative pressure for the treatment of
chronic ulcers.
Urgency of the topic: In Vietnam, the NC in the treatment of
pressure ulcers in the region with the same severity of severity is
small and individual, in particular there are very few studies on AP
anatomy of the American people mature. In addition, NC has not
applied the combination of continuous VAC with AP weight shift of
the DMD to treat the pressure ulcers of the same severity.
New contributions of the thesis: The researcher contributed to
finding the anatomical features of AP, the role of VAC in the
treatment of ulcer and the same as the treatment of ulcer with the AP
rhinitis.
Thesis structure: The thesis has 135 pages, including: 2-page
problem and objectives, 28 pages, 28 pages and 28 pages, 32 pages,
37 pages and conclusion 2 Page. There are 44 photos, 31 tabs, 14
charts, 1 chart, 11 pictures. There are 112 references including 6
Vietnamese and 96 English. Annex: 11 pages, including: data
collection form, patient list.
3
Chapter 1: OVERVIEW
1.1. Situation of Superior gluteal Artery Perforater (SGAP)
Up to now, the research on the anatomy of AP anemone by
domestic authors has not been sufficient. Koshima I. is a pioneer in
NC AP buttectomy and is used to treat ulcers. In the following years,
many NCs around the world followed this author in NC AP
aneurysm surgery and application of AP scales to treat ulcers in the
same and neighboring areas. The majority of these studies are
conducted in Europe and America. Most recently Chang'n's NC.
using 26 AP ductal anesthetics for the treatment of ulcer with the
same assertion that the AP sites of the aneurysm were dislocated
along the junction from the posterolateral spine to the dextran and the
AP appeared at the near-endpoint.
In the country: Nguyen Thai Son (2002) had an NCAA in 32
adult butt form mummies of Vietnamese adults showed that the
DMM go to the big butt of the big butt, dividing the same industry up
and down. Tran Van Anh has published the NC standard targeting
lines in the location of AP blood levels for the skin cover to cover the
ulcers of the same area.
1.2. Efficacy of VAC therapy in the treatment of chronic ulcer
Worldwide: Many authors have published results of studies on
the effect of VAC on chronic ulcer, which simultaneously reduced
the type and number of bacteria. The NC of Weed. T., Deve A.K.,
Eginton M.T. Both resulted in reduced species and bacteria per gram
of organisms. Greer said that the ulcer area decreased by 42% during
the 20-day VAC. Pham CT. Histopathological analysis of the
4
histopathological findings showed that macrophages, lymphocytes
decreased, and neoplasmic growth. Thomas D.R. It has been
suggested that VAC enhances blood perfusion to the ulcer site,
increasing the number of red blood cells, white blood cells and
oxygen volume to tissues that reduce local anaerobic bacteria.
In the country: Tran Doan Dao said that after 10 days of using
VAC, wounds reduce swelling and discharge. Nguyen Truong Giang
announced the use of VAC for acute wounds that resulted in 5-12
days of clean wounds. Tran Ngoc Diep, Chu Anh Tuan in NC
treatment of ulcers with the same with the VAC commented that with
the duration of 7 days, the wound is no longer secretions,
inflammation, clean injuries.
1.3. Application of Superior gluteal Artery Perforater Flaps enema
in the treatment of chronic obstructive ulcer
In the world: To treat ulcers of the same degree III, IV with
extensive lesions, the skin AP is also used effectively through NC:
Hurbungs A., Ismail H. E. A. Hurbungs A. published the results of 10
nostrils with NON-BREAKING HYPHEN (8209) diarrhea with
grade III and IV for good results without necrotic skin necrosis after
14 months of follow-up. Ismail H.E.A. Also announced the use of 11
rotating AP skin to cover the ulcer area of the same. These NCs
contribute to the effectiveness of Superior gluteal Artery Perforater
enema in the treatment of ulcerative colitis.
In cases of large size lesions that can not be covered by these
types of flaps, the large lobes must be covered with a large lobe to
accommodate the largest lobe designed along the posterior ligament.
cover the area of the drive. Hai H.L. and cs performed a 4-lobe AP
5
lobe appendectomy to cover the same defect area for 10 patients.
Following follow-up from 6 to 38 months, resulting in 10 live good
flaps. Yun Xie and his team used the AP scales on the buttocks to
cover the affected area. The advantage of these NCs is the large area
of the AP flap, which demonstrates clinically that the blood supply
area of the large APDE, which helps the surgeon need only one flap,
is sufficient to cover the ulcer.
Research on AP anatomy and AP flap application for the
treatment of Parkinson's ulcer has been published by many authors
worldwide. However, in the country there have been no NC for
anesthesia APD blood pressure level and only a few reports on the
application of AP flap in the treatment of ulcers in the same area with
a small number of patients. Prior to that situation, there should be a
coordinated NC from AP Anesthesia NCAA for hemorrhage to the
application of AP flap for the treatment of ulcer at the same treatment
after initial treatment with VAC.
In the country: Le Van Doan, Nguyen Viet Tien (2010), used 4
scales of dorsal skin with pedicure AP NMD in NC using large
buttock skin flaps to treat ulcer with the same results for good . Tran
Van Anh (2011) used four V-Y slides and 11 fins with a feeding
nostril AP NMD covering the same area for good results. After that,
the author uses 19 AP-weighted dumbbells to cover the chronic
obstructive ulcer.
Chapter 2: OBJECTIVES AND RESEARCH METHODS
2.1. Research subjects: NC on the carcass: AP anesthesia NCAA on
30 buttocks of 15 mature Vietnamese adults in University of
Medicine and Pharmacy. HCMC from 12/2014 to 05/2016. Clinical
6
NC: Patients diagnosed with ulcer at the same level III, IV at the
National Institute of Burns and People's Hospital 115 - Ho Chi Minh
City. HCMC from 06/2013 to 08/2016.
2.2. Methodology:
On the body: NC 30 pepper on the buttocks of 15 fresh
Vietnamese adults at University of Medicine and Pharmacy. HCMC
from 12/2014 to 05/2016. Selection criteria: Corpses without trauma
or disease of the internal iliac vessels, DMT and buttocks.
Clinical: NC intervention in a group of patients, not evidence
Sample size: applying a formula to estimate a proportion of the
population, with the key variable of interest is the survival rate of the
AP flap as follows:
Z2α/2 p (1 - p)
n =
d2
With α / 2 = 1.96. d = 0.1. p = 0.926 (according to Meltem C.
the necrotic nematode ratio was 7.4%). So the sample size for the
topic is 27. In fact, NC rescued over 37 patients. The number of
patients with NC is 25/37 patients. The number of patients with
bacterial colonies is 15/37 patients.
Standard selection: Patients with pressure ulcers at the same
level III, IV. Minimum size is 6x5 cm, maximum is 14x15 cm.
Patients are eligible for clinical, paraclinical for surgery. Patients
agree to participate in NC.
Elimination criteria: patients with grade I, II. Patients with no
indication for surgery.
2.3. NC content
7
NC: Age, gender. Purpose: Determine the origin, length,
diameter, branching of the antrum AP in the circular diameter of 5
cm centered on the junction from the frontal spine to the top of the
stump. This circle is located in the blood supply area of the DME.
VAC: Swelling: at the edge of the ulcer changes at 2 times T0,
T1. Granule: before and after VAC. Description: color, turbidity,
odor, amount determined by the fluid in the VAC system every 24
hours, at two times T0, T1. Size of the lesion (cm): Determine the
vertical, horizontal. Area of injury (cm2): vertical x horizontal.
Measure the area of ulcer at two points after the ulcer removal (T0),
before transfer (T1).
NC on transfer surgery:
- ulcer after VAC: clean seeds, red, reduce secretion, reduce
edema.
- Before and during surgery: Measure: size of ulcer, area of
ulcer, area of flap. Count the AP level of blood for the preoperative
flap through the sound of the blood vessels of the hand-held
ultrasound. Counts the number of blood pressure nodes in the
operation: by hearing the sound of a blood vessel coming from a
handheld ultrasound. Measurement: length of stalks, angle of
rotation. Surgical time: From the beginning of incision to the end of
the skin to the place where the ligament.
- Immediately after surgery: Assess the condition of the flap,
the place of the flap, the length of treatment and the wound of the
flap. Early evaluation: follow up for 3 months after surgery.
8
Table 2.1. Evaluation of early results after surgery
Good
medium
Bad
Complete life full, Necrotic partial lobe, Flap necrosis> 1/3
incision is good scar, less than 1/3 of the to tie the entire
no
Functions
aesthetics of the the wound or leaking by
operation area, no fluid must be sutured treatments. The
inflammation. area.
and section is infected, removed, replaced
other
Caesarean area,
to
be
deformation of the two.
butt.
surgical area does
not improve.
- Outcome evaluation: 3-6, 7-12, 13-24, 25-36, 37-40 months.
Based on the nature of the scars, ulcer recurrence, the ability to pinch
the operating area.
Table 2.2. Evaluate results far after surgery
Good
medium
Bad
No ulcer recurrence The
area with penguins, ulcerative
incision
is The recurrence of
but ulcerative colitis
flattened with good ulcerative, small size, with large, deep
scissors, covered self-healing wound. sores needs to be
with no leakage. Scars in the thick interfered with by
surgical area, other methods of
sclerosis. Status of plastic surgery.
epidemic.
2.4. Data processing: SPSS for Window medical statistics software.
Descriptive and univariate analyzes were conducted to determine the
relationship between AP anatomy, stalking, ulceration, and ulcer
recovery.
2.5. Ethics: Our NC adheres to ethical principles in clinical NC and
has passed the ethics committee at the National Burn Institute -
Military Academy and People's Hospital 115 - Ho Chi Minh City.
HCM.
9
Chapter 3: RESEARCH RESULTS
- Average age: 69.87 ± 9.05 (55 - 89) (age). There are 2
females (13.3%) and 13 males (86.7%).
Figure 3.2. Number of AP on each sample (n = 30)
Table 3.1. Total number of APA patients (n = 189)
Number of AP/1
specimens Number of
Total AP
specimens (n)
5 branches
6 branches
7 branches
8 branches
9 branches
Total
6
17
3
30
102
21
0
0
4
36
30
189
10
3.1.1. Diameter AP of the DMX
Table 3.2. The average diameter of the AP AE
Position AP
Average diameter (mm)
At the party committee (n = 189)
In addition to the large muscular
buttock (n = 189)
1,15 ± 0,16 (0,76 - 1,59)
1,02 ± 0,15 (0,70 -1,46)
3.1.2. Quantity distribution according to the diameter of AP arteries
Figure 3.3. Quantity according to the diameter of AP arteries on the
buttocks
3.1.3. AP length distribution outside of large axial weight
11
Figure 3.4. AP-weight distribution outside the large axonal mass
(n = 189)
3.1.4. The branching of the AP
Table 3.3. The branching of AP arteries on the buttocks
Number of
branches (n)
Quantity (%)
< 4 branches
4 - 5 branches > 5 branches
40 (21,2)
132 (69,8) 17 (9,0)
3.1.5. Length distribution of AP stems
Figure 3.5. Length of AP stenosis Longitudinal artery stenosis
(n = 189)
12
3.2.1. Age and gender of NC patients
- The youngest was 17 and the oldest was 87. The mean age was
57.5 ± 20.5 (age). Age group from 17 to 60 accounts for the highest
proportion (51.4%).
- There are 21 males (56.8%) and 16 females (43.2%). Male /
female ratio = 1.3.
3.2.2. Pathology of NC patients
Table 3.4. Percentage of baseline lesions (n = 37)
Background
The degree of ulcer is
Proportion
the same
(%)
Grade
III
Grade IV
Transverse myeloma, spinal
TB, spinal cord injury
2
10
17
32,4
48,7
TBMMN, Parkinson's disease,
severe
medical
disease,
1
exhaustion
Multiple traumatic brain injury
Radiation therapy
Total (%)
0
0
6
1
16,2
2,7
3 (8,1%) 34 (91,9%) 37 (100%)
3.2.3. Mobility status of NC patients
Table 3.5. Rate of background motion (n = 37)
Level of paralysis
Number of patients
Proportion (%)
Complete paralysis
Not completely
16
21
43,2
56,8
13
Table 3.9. Size of ulcer (n = 37)
Minimum
Max
Medium
9,2 ± 2,5
8,6 ± 2,0
82,5 ± 41,7
Length (cm)
Width (cm)
Area (cm2)
6
6
16
14
36
224
3.3. The results of VAC treatment provide the basis for the chronic
ulcer
3.3.1. Clinical characteristics of patients following negative pressure
Table 3.10. Clinical features of ulcer after VAC (n = 37)
Characteristics of lesions in place
Yes, (%)
14 (37,8)
37 (100)
15 (40,5)
37 (100)
No, (%)
23 (62,2)
0 (0)
Edgy
Granule
Odor and smell
Histopathology
22 (59,5)
0 (0)
Table 3.11. Fluctuation (n = 37)
Ulcerative fluid volume (ml)
74,9 ± 20,5 (50 -150)
25,1 ± 6,9 (20 - 40)
< 0,001
Before suction (T0)
After Smoking (T1)
p (Wilcoxon)
Table 3.12. Area of ulcer (n = 37)
Time
Area of ulcer (cm2)
82,5 ± 42,3 (36 - 224)
62,1 ± 30,9 (35 - 182)
0,020
Before suction (T0)
After Smoking (T1)
p (Wilcoxon)
14
Table 3.13. VAC implementation time (n = 37)
Suction
time (days)
Number of
cases (n)
Proportion
(%)
<7 days
7 - 14 days
> 14 - 26
Total
37
days
6
16
15
16,2
43,2
40,6
100
Table 3.14. Number of bacteria before and after suction negative
pressure
T0 (n = 15)
(5 x 103)
T1 (n = 15)
(5 x 103)
p
Time
Number VK* 2SD 289,13 313,92 71,27 113,97
0,002
3.3.3. Histopathological lesion on the wound site
Table 3.15. Transformation of ulcerative components before and
after VAC (n = 25)
Test time
Tracking Targets
p
Before VAC
After VAC
Number of
inflammatory cells
Number of fibroblasts
Number of neon
circuits
31,08 ± 3,161 19,68 ± 4,018 <0,05
9,52 ± 1,982
2,44 ± 0,821
17,36 ± 1,955 <0,05
4,04 ± 0,676 <0,05
15
3.4. The results of the treatment of chronic ulcer are the same as the
AP rhinitis
3.4.1. Flap and tie
We used 38 lobes in 37 patients because of a wide-spread pattern of
patients using 2 flanks of the buttocks at the same time.
Figure 3.11. Flap and flap combination (n = 38)
3.4.2. Quantity AP
Table 3.16. The number of APs expected on each of the preceding
passes (n = 38)
The number of flaps
Proportion
Quantity AP / flap
(%)
Slipping.
Propeller
1 branches
2 branches
3 branches
4 branches
5 branches
Total number
1
1
5
2
0
9
0
8
1 (2,6)
9 (23,7)
22 (57,9)
4 (10,5)
2 (5,3)
17
2
2
29
38 (100)
16
Table 3.17. Number of AP on each flap in turn
The number of flaps
Proportion
Quantity AP / flap
(%)
Slipping
Propeller
1 branches
2 branches
3 branches
4 branches
5 branches
Total number
1
3
4
1
0
9
1
10
16
2
2 (5,3)
13 (34,2)
20 (52,6)
3 (7,9)
0
0 (0)
29
38 (100)
Table 3.18. Average AP per stripe
Number
Medium
2,9 ± 0,8
2,6 ± 0,7
T (test)
Before transfer
In turn
p = 0,104
3.4.3. Length of stalks
Table 3.19. Length of stalks
Number of flute types
Length of
stalks
Proportion
(%)
Slipping
Propeller
2 cm
3 cm
0
5
3
1
9
1
23
5
1 (2,6)
28 (73,7)
8 (21,1)
1 (2,6)
4 cm
5 cm
0
Total
number
29
38 (100)
17
3.4.4. Size of the flap
Table 3.20. Size of the flap
Yếu tố
Average value
Area of the flap (cm²)
Length of the flap (cm)
Width of the flap (cm)
111,6 ± 27,0 (60 - 180)
13,6 ± 2,2 (10 - 18)
8,1 ± 1,2 (6 - 10)
3.4.5. Survival rate after transfer (n = 38)
Table 3.21. Condition after transfer
Number of flute
Status flips after
Proportion
types
transfer
(%)
Slide Propeller
Live the whole
8
26
34/38
(89,5)
Necrotic lip
Complete necropsy
Total number
1
0
9
3
0
4/38 (10,5)
0 (0)
29
38/38 (100)
Table 3.22. Injury time recovered (days)
Time wound recovered
7-14 >14-21 >21-28 Proportio
n (%)
Proportion (%)
23 (62,2)
6
8 (21,6) 37 (100)
(16,2)
18
Table 3.24. Average duration of treatment
Patients using the flap
n
Duration of TB
treatment
p
Slipping
9
25,8 ± 10,5 (10 - 40)
0,916
Rotor blades
28 25,4 ± 9,3 (10 - 44)
3.4.6. Swing angle swirl in the rotor blade
Figure 3.12. Turning angle (n = 29)
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