Kumar Umesh, Jain Pradeep
Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Plast Surg. 2018 Jan-Apr;51(1):70-76. doi: 10.4103/ijps.IJPS_15_18.
The objective of the study was to determine the feasibility of infragluteal fasciocutaneous flap in recurrent ischial pressure sore.
In our study, from 2015 to 2017, nine patients suffering from recurrent ischial sore with scars of previous surgery were managed with infragluteal fasciocutaneous flap. Wound bed was prepared by surgical debridement and negative pressure wound therapy in each case. In two cases, gracilis muscle flap was used as adjuvant to fill up the residual cavity. Donor area of flap was primarily closed.
Infragluteal fasciocutaneous flap was used in all nine cases. Superficial distal congestion was present in two cases. Haematoma (1) and infection (1) at flap donor site occurred. Recurrence of ulcer was observed in two cases which were managed by bursectomy and advancement of the bridge segment of the original infragluteal fasciocutaneous flap. All flaps survived without any major complication.
Ischial pressure sores have a tendency of recurrence after conservative or flap surgery. Scars due to previous surgeries adjacent to the pressure sore preclude the use of local skin or muscle flap. Infragluteal fasciocutaneous flap is a thick reliable fasciocutaneous flap that can be used for resurfacing recurrent ischial pressure sore. This flap has an axial pattern blood supply along with rich subfascial and fascial plexus supplied by various perforators.
Infragluteal fasciocutaneous flap is reliable option for managing recurrent ischial sore as it transposes well-vascularised thick fasciocutaneous flap from adjacent posterior thigh and its bridge segment can be further used in case of recurrence.
本研究的目的是确定臀下筋膜皮瓣用于复发性坐骨压力性溃疡的可行性。
在我们的研究中，2015年至2017年期间，9例患有复发性坐骨溃疡且有既往手术瘢痕的患者接受了臀下筋膜皮瓣治疗。每例患者均通过手术清创和负压伤口治疗来准备创面床。2例患者使用股薄肌瓣作为辅助以填充残余腔隙。皮瓣供区一期缝合。
9例患者均使用了臀下筋膜皮瓣。2例出现远端浅表性充血。皮瓣供区发生血肿（1例）和感染（1例）。观察到2例溃疡复发，通过滑囊切除术和原臀下筋膜皮瓣桥接段推进进行处理。所有皮瓣均存活，无任何严重并发症。
坐骨压力性溃疡在保守治疗或皮瓣手术后有复发倾向。压力性溃疡附近既往手术留下的瘢痕妨碍了局部皮肤或肌皮瓣的使用。臀下筋膜皮瓣是一种厚实可靠的筋膜皮瓣，可用于复发性坐骨压力性溃疡的创面覆盖。该皮瓣具有轴型血供，同时有丰富的由各种穿支供应的筋膜下和筋膜丛。
臀下筋膜皮瓣是治疗复发性坐骨溃疡的可靠选择，因为它可转移来自相邻大腿后侧血运良好的厚实筋膜皮瓣，并且在复发时其桥接段可进一步利用。
