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 d

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issertation on May 201 The dissertation can be found at: National Library VIETNAM MILITARY MEDICAL UNIVERSITY LIBRARY 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 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. 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 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 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 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: n = Z2α/2 p (1 - p) 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 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. Table 2.1. Evaluation of early results after surgery Good medium Bad Complete life full, incision is good scar, no inflammation. Functions and aesthetics of the operation area, no deformation of the butt. Necrotic partial lobe, less than 1/3 of the area. Caesarean section is infected, the wound or leaking fluid must be sutured two. Flap necrosis> 1/3 to tie the entire area, to be removed, replaced by other treatments. The 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 area with penguins, flattened with good scissors, covered with no leakage. The incision is ulcerative but ulcerative, small size, self-healing wound. Scars in the thick surgical area, sclerosis. Status of epidemic. The recurrence of ulcerative colitis with large, deep sores needs to be interfered with by other methods of plastic surgery. 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. 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 specimens (n) Total AP 5 branches 6 30 6 branches 17 102 7 branches 3 21 8 branches 0 0 9 branches 4 36 Total 30 189 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) 1,15 ± 0,16 (0,76 - 1,59) In addition to the large muscular buttock (n = 189) 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 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) < 4 branches 4 - 5 branches > 5 branches Quantity (%) 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) 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 the same Proportion (%) Grade III Grade IV Transverse myeloma, spinal TB, spinal cord injury 2 10 32,4 TBMMN, Parkinson's disease, severe medical disease, exhaustion 1 17 48,7 Multiple traumatic brain injury 0 6 16,2 Radiation therapy 0 1 2,7 Total (%) 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 16 43,2 Not completely 21 56,8 Table 3.9. Size of ulcer (n = 37) Minimum Max Medium Length (cm) 6 16 9,2 ± 2,5 Width (cm) 6 14 8,6 ± 2,0 Area (cm2) 36 224 82,5 ± 41,7 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, (%) No, (%) Edgy 14 (37,8) 23 (62,2) Granule 37 (100) 0 (0) Odor and smell 15 (40,5) 22 (59,5) Histopathology 37 (100) 0 (0) Table 3.11. Fluctuation (n = 37) Ulcerative fluid volume (ml) Before suction (T0) 74,9 ± 20,5 (50 -150) After Smoking (T1) 25,1 ± 6,9 (20 - 40) p (Wilcoxon) < 0,001 Table 3.12. Area of ulcer (n = 37) Time Area of ulcer (cm2) Before suction (T0) 82,5 ± 42,3 (36 - 224) After Smoking (T1) 62,1 ± 30,9 (35 - 182) p (Wilcoxon) 0,020 Table 3.13. VAC implementation time (n = 37) Suction time (days) <7 days 7 - 14 days > 14 - 26 days Total Number of cases (n) 6 16 15 37 Proportion (%) 16,2 43,2 40,6 100 Table 3.14. Number of bacteria before and after suction negative pressure Time T0 (n = 15) (5 x 103) T1 (n = 15) (5 x 103) p 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) Tracking Targets Test time p Before VAC After VAC Number of inflammatory cells 31,08 ± 3,161 19,68 ± 4,018 <0,05 Number of fibroblasts 9,52 ± 1,982 17,36 ± 1,955 <0,05 Number of neon circuits 2,44 ± 0,821 4,04 ± 0,676 <0,05 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) Quantity AP / flap The number of flaps Proportion (%) Slipping. Propeller 1 branches 1 0 1 (2,6) 2 branches 1 8 9 (23,7) 3 branches 5 17 22 (57,9) 4 branches 2 2 4 (10,5) 5 branches 0 2 2 (5,3) Total number 9 29 38 (100) Table 3.17. Number of AP on each flap in turn Quantity AP / flap The number of flaps Proportion (%) Slipping Propeller 1 branches 1 1 2 (5,3) 2 branches 3 10 13 (34,2) 3 branches 4 16 20 (52,6) 4 branches 1 2 3 (7,9) 5 branches 0 0 0 (0) Total number 9 29 38 (100) Table 3.18. Average AP per stripe Number Medium T (test) Before transfer 2,9 ± 0,8 p = 0,104 In turn 2,6 ± 0,7 3.4.3. Length of stalks Table 3.19. Length of stalks Length of stalks Number of flute types Proportion (%) Slipping Propeller 2 cm 0 1 1 (2,6) 3 cm 5 23 28 (73,7) 4 cm 3 5 8 (21,1) 5 cm 1 0 1 (2,6) Total number 9 29 38 (100) 3.4.4. Size of the flap Table 3.20. Size of the flap Yếu tố Average value Area of the flap (cm²) 111,6 ± 27,0 (60 - 180) Length of the flap (cm) 13,6 ± 2,2 (10 - 18) Width of the flap (cm) 8,1 ± 1,2 (6 - 10) 3.4.5. Survival rate after transfer (n = 38) Table 3.21. Condition after transfer Status flips after transfer Number of flute types Proportion (%) Slide Propeller Live the whole 8 26 34/38 (89,5) Necrotic lip 1 3 4/38 (10,5) Complete necropsy 0 0 0 (0) Total number 9 29 38/38 (100) Table 3.22. Injury time recovered (days) Time wound recovered 7-14 >14-21 >21-28 Proportion (%) Proportion (%) 23 (62,2) 6 (16,2) 8 (21,6) 37 (100) 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) 3.4.7. The time period Figure 3.13. Surgical time (n = 37) Table 3.23. Duration of treatment (n = 37) Duration of treatment (Day) ≤ 30 > 30 PFisher Patients using slides 5 (55,6) 4 (44,4) 0,705 Number of patients using rotor blades 18 (64,3) 10 (35,7) Total patients (%) 23 (62,2) 14 (37,8) // 3.4.8. Symptoms 3.4.8.1. In surgery: We monitor complications right in the surgery and treat the complications immediately. Therefore, no cases of partial or complete necrosis. 3.4.8.2. In far-sightedness: Mildiness on the surface of the flap 3.4.9. Early evaluation results Table 3.25. Results after 1 to 3 months (n = 37) Status flute Flute type Proportion (%) Slide V-Y (n=9) Propeller (n=29) Good 8 25 33/37 (89,2) medium 1 3 4/37 (10,8) Bad 0 0 0 (0) 3.4.10. Evaluate the results far Table 3.26. Results 3-6 months (n = 23) Result Number of patients Proportion (%) Good 23 100,0 medium 0 0 Bad 0 0 Total 23 100,0 Table 3.27. Results from 7 to 12 months (n = 20) Result Number of patients Proportion (%) Good 20 100,0 medium 0 0 Bad 0 0 Total 8 100,0 Table 3.28. and 3.29. Results from 25 to 40 months (n = 9) Result Number of patients Proportion (%) Good 9 100,0 medium 0 0 Bad 0 0 Total 9 100,0 Average follow-up: 19.7 ± 14 (months). Chapter 4: DISCUSSION 4.1. Anatomical features of Superior gluteal Artery Perforater (AP) 4.1.1. Quantity Artery Perforater (AP) In our NC, the number of AP from 5 branches to 9 branches (table 3.1). Of these, there were 6 specimens with 5 AP in the circle, 20.0% in the circle, 17 in the six branches, 56.7% in the other, 7 in the AP, 10% in the AP, There are 4 9-branch, 13.3%. Number of specimens with AP number of 6 branches is higher than other groups (56.7%). Especially 13.3% of the template has 9 AP. The mean of AP is 6.3 ± 1.2. NC of Koshima I. confirmed in the buttocks area of ​​about 20-25 AP for the skin derived from both the DMD and the lower buttocks. Vasile J.V. (2009) used magnetic resonance imaging for CT scans in 32 buttocks: 160 AP, of which 92 AP DTMD, 6 of which were close to the buttocks, AP variability 1 - 5 branches (average 2.9 branches). 4.1.2. The diameter of the (AP) The average diameter at the starting point of the AP in this NC is 1.58 ± 0.13mm suitable for Tanasit T. (NC) 2.40 ± 0.52mm. The diameter of the AP at the origin is about 0.2 mm larger than the AP itself at the skin contact site. This index is significant for NC application of free AP scales. The AP diameter near our hindquarters is 1.02 ± 0.15 mm, which is smaller than that of Tanasit T. (1.22 ± 0.22 mm). As such, our NC asserts that a diameter of AP greater than 1 mm will help the blood supply to the flap plentiful and safe transfer. 4.1.3. Length of (AP) Our results on the length of the AP from the incidence of onset to extra-large butal mass were on average 10.2 ± 0.8 cm (102.18 ± 7.86 mm) (Figure 3.5 ) are similar to those of the authors. The length of the AP in our NC was investigated and measured after backward reconstruction of each AP (found in a circle of 5 cm diameter) of the original branch of the branch of the agro-ecological DME. 4.1.4. The length of the AP stiffening of the buttock mass Georgantopoulou A. (2014) determined the length of the nostril AP in the musculature of 5.3 cm, the total length of the free-flowing stalk was 9.8 cm, the length of the external muscle to the buttocks was on average 4.5 cm in length are similar to those of the circular motif in their NC. Our NC, the upper length is 41.95 ± 7.15mm (4.2 ± 0.7cm). Significance of the length of the scrotum outside of the anesthetic AP helps us to design the length of the stalk, the length of the flap, the angle of rotation, pushed the lap cover covering the area of ​​the ulcer. 4.1.5. Goal line Koshima I. (1993) was the first NC for the occurrence of an AP chromosome and applied it to the buttocks of the buttocks. The author presents the anatomical landmarks of the pericardium on the skin of the buttocks, which are the junctions on the junction from the posterior spine to the large vertebrae. Our NC anesthesia is similar to the NC of Fade G. The NC NC is performed by computerized tomography in the buttocks of 100 patients. Results show that the location of skin AP Dermatitis in the circle of 3 cm in diameter is from 92.2 to 99.8%. The distance from the front spine to the top of the staped joint is 192 mm in length, the length of which is roughly equivalent to the distance from the top of the capillary crest to the top of the sternum in our NC and the distance between the third Approximately 64mm in length, in line with the 60mm circle diameter selection in NC AP surgery. Based on this author's NC, the average distance of the junction from the bony to the large to the large intersection is 152 mm, the center of which is about 76 mm from the bones. The circumference of the circle is 60 mm in diameter. This surgery has an AP enema that will assist in the design of AP lesions near the lesion area. 4.2. The results of VAC treatment provide the basis for the chronic ulcer 4.2.1. Clinical Soft tissue necrosis and osteonecrosis of the same stool were recorded in the majority of cases with clean-cut treatment before aspiration of VAC. The onset of edema was reduced to 62.2% indicating a VAC effect of this symptom. Diarrhea at the loss decreased to 59.5%, but still a high rate of cases of foul odor. We observed ulcerated epithelial lesions on all ulcers after aspiration of VAC. 4.2.1.1. Evaluation of fluid secretions Diarrhea is a sign of chronic infection. Therefore, NC often refers to the nature of the secretion of numbers, colors, odors. We recorded the number of secretions before and after the VAC: the average discharge was 74.9 ± 20.5 ml, followed by the average aspiration of 25.1 ± 6.9 ml. The number of secretions after suction decreased significantly (table 3.11). Pre-VAC volume was 150 ml / day in 3 patients with large ulcer, multiple edema. After VAC, at the time of N1, the number of patients dropped significantly. This demonstrates that VAC therapy helps ulcers reduce swelling, infection in place. 4.2.1.2. Narrowing area of ​​ulcer Moues C.M. (2004) compared the efficacy of VAC therapy with conventional bandwere in treatment LIST OF PUBLIC WORKS RESULTS OF RESEARCH THESIS 1. Nguyễn Văn Thanh, Trần Vân Anh, Nguyễn Văn Huệ (2016). Nghiên cứu giải phẫu nhánh xuyên động mạch mông trên. Ứng dụng trong tạo vạt da cân vùng mông có cuống nuôi. Tạp chí y dược học quân sự, 41(9): 30-35. 2. Nguyễn Văn Thanh, Trần Vân Anh, Nguyễn Văn Huệ (2017). Nghiên cứu ứng dụng điều trị loét vùng cùng cụt độ III, IV bằng vạt da cân có cuống mạch nuôi là nhánh xuyên động mạch mông trên. Tạp chí y học Quân sự, 1: 161-167.

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