Su W G, Li D P, Xing P P, Xu L G, Shi F C, Wen B, Niu X H
Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China.
Zhonghua Shao Shang Za Zhi. 2017 Sep 20;33(9):545-549. doi: 10.3760/cma.j.issn.1009-2587.2017.09.004.
To explore effects of perforator flaps combined with muscle flaps for repairing grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients. Nine elderly patients with grade Ⅳ pressure ulcers in ischial tuberosity were hospitalized in our burn ward from April 2014 to April 2017. Size of wounds ranged from 5 cm×3 cm to 12 cm×7 cm, and depth of sinus ranged from 6 to 22 cm. After admission, emergency debridement or debridement in selective time was performed. After debridement, the wounds were treated with continuous vacuum assisted closure therapy. After the treatment for 1 to 2 weeks, tissue flaps repair operations were performed. Four patients were repaired with inferior gluteal artery perforator flaps combined with long head of biceps femoris muscle flaps. Three patients were repaired with inferior gluteal artery perforator flaps combined with semimembranous muscle flaps. One patient was repaired with inferior gluteal artery perforator flap combined with gracilis muscle flap. One patient was repaired with femoral profound artery perforator flap combined with gluteus maximus muscle flap, and the distal area of femoral profound artery perforator flap of the patient which showed intraoperative cyanosis of 6 cm×4 cm was thinned to medium thickness skin to cover the muscle flap. The other eight patients showed no abnormality during operation. Size of perforator flaps ranged from 7 cm×5 cm to 14 cm×12 cm, and size of muscle flaps ranged from 11 cm×4 cm to 24 cm×6 cm. The donor sites of flaps were all sutured directly. The tissue flaps and skin graft of all patients survived well after operation. During follow-up of 8 to 35 weeks, operative area of all patients showed good shape and texture, with no local diabrosis or recurrence of pressure ulcers. The combination of perforator flaps and muscle flaps is effective in repairing and reducing recurrence of grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients.
探讨穿支皮瓣联合肌皮瓣修复老年患者坐骨结节Ⅳ度压疮的效果。2014年4月至2017年4月，9例坐骨结节Ⅳ度压疮老年患者入住我院烧伤病房。创面大小为5 cm×3 cm至12 cm×7 cm，窦道深度为6至22 cm。入院后，进行急诊清创或择期清创。清创后，创面采用持续负压封闭引流治疗。治疗1至2周后，进行组织瓣修复手术。4例采用臀下动脉穿支皮瓣联合股二头肌长头肌皮瓣修复。3例采用臀下动脉穿支皮瓣联合半膜肌肌皮瓣修复。1例采用臀下动脉穿支皮瓣联合股薄肌肌皮瓣修复。1例采用股深动脉穿支皮瓣联合臀大肌肌皮瓣修复，术中见该例股深动脉穿支皮瓣远端6 cm×4 cm区域发绀，将其削薄为中厚皮片覆盖肌皮瓣。其余8例手术过程顺利。穿支皮瓣大小为7 cm×5 cm至14 cm×12 cm，肌皮瓣大小为11 cm×4 cm至24 cm×6 cm。皮瓣供区均直接缝合。所有患者术后组织瓣及植皮均成活良好。随访8至35周，所有患者手术区域外形及质地良好，无局部坏死或压疮复发。穿支皮瓣联合肌皮瓣修复老年患者坐骨结节Ⅳ度压疮效果良好，可降低复发率。
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