Legemate Catherine M, van der Kwaak Monique, Gobets David, Huikeshoven Menno, van Zuijlen Paul P M
Red Cross Hospital, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Rehabilitation Centre, Heliomare, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands.
J Plast Reconstr Aesthet Surg. 2018 Jun;71(6):889-894. doi: 10.1016/j.bjps.2018.01.032. Epub 2018 Feb 7.
The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold.
A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery).
Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers.
The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.
坐骨区域是压疮最易累及的部位，与其他受累部位相比，其复发率和并发症发生率最高。基于阴部内动脉丰富的可用穿支血管以及臀下皱襞处多余的皮肤，我们研发了一种实用且安全的带蒂皮瓣用于坐骨压疮的修复。
对2010年3月至2017年3月期间所有采用阴部内动脉穿支推进皮瓣（PIPAP皮瓣）进行坐骨压疮修复的患者进行回顾性队列研究。皮瓣沿臀皱襞设计。用多普勒探头在臀皱襞内侧区域标记阴部动脉的皮肤穿支。手术在折刀位进行，皮瓣在筋膜上平面掀起。对患者的轻微（无需额外手术）和严重并发症（需要额外手术）进行评估。
共纳入27例患者（34个皮瓣）。中位随访期为38个月（四分位间距37）。所有手术均实现了供区一期缝合，仅1个皮瓣需要进行肌瓣转移以填充死腔。平均手术时间为60±21分钟。6个皮瓣（9%）出现伤口愈合问题，但无需额外手术。在需要二次手术的9个皮瓣（27%）中，3个（9%）是由于溃疡复发所致。
PIPAP皮瓣是坐骨压疮修复的一种安全可靠的选择，与现有技术相比尤其如此。此外，它相对于其他技术具有显著优势，包括供区并发症最少、保留大腿后部皮肤、臀纹完整性以及可靠的血运。
