Department of Plastic and Reconstructive Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea.
J Plast Reconstr Aesthet Surg. 2011 Sep;64(9):1197-201. doi: 10.1016/j.bjps.2011.04.010. Epub 2011 Jun 8.
The distally extended tensor fascia lata flap is a good choice to provide sufficient tissue bulk for a deep trochanteric sore defect. However, this flap can result in necrosis of the distal skin due to inadequate blood supply, failure of primary closure at the donor site or suture separation at the proximal donor site. The viability of the distal flap depends on the longitudinal subcutaneous plexi of the perforators anastomosing through multiple small-calibre vessels. If the subcutaneous and fasciocutaneous plexi are maximally preserved, the distal flap may be viable. It may also allow the flap to be narrower at the proximal portion, allowing the donor site to be primarily closed without tension. We performed a V-shaped, distally de-epithelialised, extended tensor fascia lata flap with a wide base of the iliotibial tract. The de-epithelialised distal flap was double-folded to fill the dead space of the defect. A key surgical tip to improve blood supply to the distal flap was to preserve the iliotibial tract 1.5 cm beyond both borders of the V-shaped skin incision. A total of 14 trochanteric wounds were successfully covered in 11 patients without complication. This flap had the advantages of having soft-tissue bulk, a reliable blood supply and primary donor-site closure. This flap may provide a good option for the reconstruction of deep trochanteric pressure sores.
远端延伸阔筋膜张肌皮瓣是为转子深部溃疡缺损提供足够组织量的良好选择。然而，由于血供不足、供区一期缝合失败或近端供区缝线分离，该皮瓣可能导致远端皮肤坏死。远端皮瓣的存活取决于穿支血管的纵向皮下血管丛通过多条小口径血管吻合。如果最大程度地保留皮下和筋膜皮血管丛，远端皮瓣可能存活。这也可能使皮瓣在近端部分更窄，从而使供区能够无张力地一期缝合。我们采用了一种V形、远端去上皮化、延伸的阔筋膜张肌皮瓣，其髂胫束基部较宽。去上皮化的远端皮瓣折叠双层以填充缺损的死腔。改善远端皮瓣血供的一个关键手术技巧是在V形皮肤切口的两侧边缘向外1.5 cm处保留髂胫束。11例患者共14处转子伤口成功覆盖，无并发症。该皮瓣具有软组织量充足、血供可靠和供区一期闭合的优点。该皮瓣可能为转子深部压疮的重建提供一个良好的选择。
