Buchanan Lauren E, Campbell Chris A
Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville, Va. and.
Department of Plastic Surgery, University of Virginia Health System, Charlottesville, Va.
Plast Reconstr Surg Glob Open. 2019 May 31;7(5):e2054. doi: 10.1097/GOX.0000000000002054. eCollection 2019 May.
The chronic inflammation of hidradenitis suppurativa can cause painful nodules, draining abscesses, sinus tracts, and fibrous scars. This long-term cutaneous inflammation in rare circumstances can lead to malignant transformation producing an aggressive cutaneous malignancy referred to as a Marjolin's ulcer. Particularly when a Marjolin's ulcer involves the sacral region, resection and reconstruction can be challenging. We present the case of a patient with a recurrent Marjolin's ulcer originating from a hidradenitis wound bed overlying and involving the sacrum. Previous radiation, large defect size, and sacral and perianal involvement necessitated the use of a multiflap approach. An extended transpelvic vertical rectus abdominis myocutaneous flap, bilateral gluteal advancement flaps, and a delayed transverse back flap were used to reconstruct the defect after abdominoperineal resection and nerve-sparing partial sacrectomy. Flap choice was derived by dividing the defect into anatomic subunits and considering intrapelvic defect volume, creating a systematic approach that led to successful reconstruction and functional restoration.
化脓性汗腺炎的慢性炎症可导致疼痛性结节、引流性脓肿、窦道和纤维瘢痕。这种长期的皮肤炎症在罕见情况下可导致恶性转化，产生一种侵袭性皮肤恶性肿瘤，称为马乔林溃疡。特别是当马乔林溃疡累及骶骨区域时，切除和重建可能具有挑战性。我们报告一例复发性马乔林溃疡患者，其起源于覆盖并累及骶骨的化脓性汗腺炎创面。既往放疗、缺损面积大以及骶骨和肛周受累使得有必要采用多皮瓣方法。在腹会阴切除和保留神经的部分骶骨切除术后，使用延长经盆腔垂直腹直肌肌皮瓣、双侧臀大肌推进皮瓣和延迟背阔肌皮瓣重建缺损。皮瓣选择是通过将缺损划分为解剖亚单位并考虑盆腔内缺损体积得出的，从而形成一种系统方法，实现了成功的重建和功能恢复。
