Homma K, Murakami G, Fujioka H, Fujita T, Imai A, Ezoe K
Division of Plastic and Reconstructive Surgery, the Department of Anatomy, Sapporo Medical University, Japan.
Plast Reconstr Surg. 2001 Dec;108(7):1990-6; discussion 1997. doi: 10.1097/00006534-200112000-00023.
This study describes the use of the posteromedial thigh fasciocutaneous flap for the treatment of ischial pressure sores. The authors prefer this flap because it is the fasciocutaneous flap nearest to the ischial region, it is easy to raise, and it causes no donor-site morbidity. In this study, 11 ischial pressure sores in 10 paraplegic patients were closed using the posteromedial thigh fasciocutaneous flaps. All flaps survived, although two caused distal necrosis; after these same two flaps were readvanced, they survived. After an average follow-up time of 77 months, seven of the 10 patients have had no recurrence of ulcers. This fasciocutaneous flap was previously described by Wang et al. However, this study revealed that the arrangement of the vascular pedicle was different from that described by Wang et al. To reveal the vascular supply of this flap, anatomic dissections were conducted. The source of circulation to this flap was the suprafascial vascular plexus, in addition to the musculocutaneous perforator. The dominant pedicle was the musculocutaneous perforator from either the adductor magnus muscle or the gracilis muscle. The key to safe elevation of this flap was the accurate outlining of the skin island directly over the vascular pedicle and the preservation of the proximal fascial continuity. Of the 11 flaps, two viability problems occurred. These partial flap losses resulted from the failure to properly include the perforator. It is the authors' conclusion that the width of the flap should be greater than 5 cm. In addition, it is safe to make a flap within a 1:3 base-to-length ratio in a fatty, diabetic patient. This posteromedial thigh fasciocutaneous flap was found to be a valuable alternative for reconstruction of primary or recurrent ischial pressure ulcers.
本研究描述了采用股后内侧筋膜皮瓣治疗坐骨压力性溃疡。作者之所以青睐此皮瓣，是因为它是最接近坐骨区域的筋膜皮瓣，易于掀起，且不会导致供区出现并发症。在本研究中，10例截瘫患者的11处坐骨压力性溃疡采用股后内侧筋膜皮瓣进行修复。所有皮瓣均存活，尽管有2例出现远端坏死；这2例皮瓣再次推进后存活。平均随访77个月后，10例患者中有7例溃疡未复发。该筋膜皮瓣此前由Wang等人描述过。然而，本研究发现其血管蒂的走行与Wang等人描述的不同。为揭示该皮瓣的血供，进行了解剖学研究。该皮瓣的血供来源除了肌皮穿支外，还有筋膜上血管丛。主要血管蒂是来自大收肌或股薄肌的肌皮穿支。安全掀起此皮瓣的关键在于准确勾勒出血管蒂上方的皮岛，并保留近端筋膜的连续性。11例皮瓣中有2例出现存活问题。这些部分皮瓣坏死是由于未正确包含穿支所致。作者得出结论，皮瓣宽度应大于5 cm。此外，对于肥胖的糖尿病患者，以1:3的长宽比制作皮瓣是安全的。发现股后内侧筋膜皮瓣是修复原发性或复发性坐骨压力性溃疡的一种有价值的替代方法。
