Senda H, Okamoto H
Department of Orthopaedic Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa, Nagoya, Aichi, 464-8547, Japan.
Department of Orthopaedic Surgery, Nagoya City University.
JPRAS Open. 2020 Oct 6;26:54-59. doi: 10.1016/j.jpra.2020.09.006. eCollection 2020 Dec.
We report the case of a 95-year-old man with soft tissue deficiency associated with a pubic abscess that occurred 30 years after prostate cancer surgery and radiation therapy. A fistula with purulent discharge without any obvious cause appeared in the midline of the lower abdomen and progressed to a soft tissue defect in which several calcium phosphate stones of 5-8 mm in diameter were found. Computed tomography showed calcium deposits on the surface of the pubis and irregular zonal calcifications extending from the pubis to the medial region of both thighs. Conservative treatment did not improve the patient's condition; thus, surgical treatment was performed. The pedicled rectus femoris muscle flap was elevated from the left thigh and transferred to fill the tissue defect, then a split thickness skin graft was applied on it. The tissue defect was successfully repaired, and the patient was able to regain ambulation ability. In the present case, it was presumed that urine exudation around the bladder due to radiation cystitis was involved in the formation of ectopic calculi and subsequent infection. In reconstructing a complex defect associated with infection, using muscle flaps to fill the dead space with well vascularized tissue is considered to be appropriate. In our case, we chose a rectus femoris muscle flap, which has advantages in volume and versatility of transposition owing to long vascular pedicle and requires no microsurgical vascular anastomosis. As a result, the preoperative activity was maintained, the infection was treated, and a good course was obtained.
我们报告了一例95岁男性患者，其软组织缺损与前列腺癌手术和放射治疗30年后发生的耻骨脓肿有关。下腹中线出现了一个无明显原因的脓性分泌物瘘管，并发展为软组织缺损，在其中发现了数颗直径为5-8毫米的磷酸钙结石。计算机断层扫描显示耻骨表面有钙沉积，以及从耻骨延伸至双侧大腿内侧区域的不规则带状钙化。保守治疗未能改善患者病情，因此进行了手术治疗。从左大腿掀起带蒂股直肌肌瓣并转移以填充组织缺损，然后在其上应用中厚皮片移植。组织缺损成功修复，患者能够恢复行走能力。在本病例中，推测放射性膀胱炎导致膀胱周围尿液渗出与异位结石的形成及随后的感染有关。在重建与感染相关的复杂缺损时，使用肌瓣用血管丰富的组织填充死腔被认为是合适的。在我们的病例中，我们选择了股直肌肌瓣，由于其血管蒂长，在体积和转位的通用性方面具有优势，且无需显微外科血管吻合。结果，患者术前的活动能力得以维持，感染得到治疗，病情进展良好。
