Singh Roop, Wadhwani Jitendra, Rohilla Rajesh Kumar, Kaur Kiranpreet
1Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India.
2Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India.
Spinal Cord Ser Cases. 2019 Feb 5;5:15. doi: 10.1038/s41394-019-0157-0. eCollection 2019.
Trochanteric pressure ulcers (PrUs) are difficult to treat and are often complicated by infection spreading to the hip joint. We review three cases from India where proximal femoral resection and pedicled Tensor Fascia Lata (TFL) flapping was used in the management of infected deep trochanteric ulcers communicating to the hip joint.
Three patients had a total of four trochanteric PrUs communicating to the hip joint. Proximal femoral resection along with radical debridement of the pressure ulcer (PrU) was the first step in our surgical protocol. Serial debridements were performed to make the resulting cavity healthier and ready for the subsequent flap surgery. TFL flapping was done to cover the raw area of the PrU and the donor site was closed either primarily or with a split skin graft. All patients were males with AIS A spinal cord injury (SCI) and stage 4 PrUs in the trochanteric region. One patient had bilateral trochanteric ulcers. There was complete healing of all PrUs with improvement in wheelchair mobility, and general health.
PrUs are a common complication of patients with SCI and are often considered one of the most neglected issues of health care delivery in India. Proximal femoral resection with pedicled TFL muscle flap is a versatile and reliable procedure for the coverage of recalcitrant trochanteric PrU with hip joint involvement. Minimal donor site morbidity occurs.
转子部压疮难以治疗，且常因感染扩散至髋关节而复杂化。我们回顾了来自印度的三例病例，其中采用股骨近端切除术和带蒂阔筋膜张肌（TFL）皮瓣转移术治疗与髋关节相通的深部感染性转子部溃疡。
三名患者共有四处与髋关节相通的转子部压疮。我们手术方案的第一步是股骨近端切除术并对压疮进行彻底清创。进行了一系列清创术，以使形成的腔隙更健康，为后续的皮瓣手术做好准备。采用TFL皮瓣转移术覆盖压疮的创面，供区要么直接缝合，要么用中厚皮片移植覆盖。所有患者均为男性，患有美国脊髓损伤协会（AIS）A级脊髓损伤（SCI），转子部为4期压疮。一名患者双侧转子部溃疡。所有压疮均完全愈合，轮椅活动能力和总体健康状况有所改善。
压疮是脊髓损伤患者的常见并发症，在印度常被视为医疗保健中最被忽视的问题之一。带蒂TFL肌皮瓣的股骨近端切除术是一种多功能且可靠的手术方法，用于覆盖累及髋关节的顽固性转子部压疮。供区并发症极少。
