From the Department of Burns and Plastic Surgery.
Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Ann Plast Surg. 2022 Jan 1;88(1):105-113. doi: 10.1097/SAP.0000000000002941.
Pressure sores are agonizing complications of chronically bedridden patients. The management of these lesions particularly with respect to grades III and IV lesions are chiefly surgical and involves a multidisciplinary approach. Although there are a variety of local flap options, like fasciocutaneous flaps, musculocutaneous flaps, perforator flaps, and combinations of these to choose from, there is a paucity of literature regarding which flap is better among these in terms of complication and recurrence rates.
The databases searched were as follows: Cochrane Central Register of Controlled trials (January 2000 to July 2020), MEDLINE (January 2000 to July 2020), and EMBASE (January 2000 to August of 2020). Key words used were "pressure ulcer," "flaps," "surgery," "pressure sore" with limits, "human," and "English." Primary outcomes were "overall complication rates" and "recurrence rates." Overall complication was further categorized as flap necrosis, flap dehiscence, infection, and others.
Thirty-nine articles were included in the final analysis. There was a statistically significant difference among the various types of flaps for overall complication, flap dehiscence, infection, flap necrosis, and recurrence rates.
Our study indicates that musculocutaneous flaps have lower recurrence rates, and combined flaps have lower complication rates. However, various other factors, like donor site morbidity, initial defect size, operating time, intraoperative blood loss, salvage options in case of recurrence, should also be considered while choosing a flap to reconstruct a defect.
压疮是慢性卧床患者的痛苦并发症。这些病变的治疗，特别是对于 3 级和 4 级病变，主要是手术治疗，并涉及多学科方法。虽然有多种局部皮瓣可供选择，如筋膜皮瓣、肌皮瓣、穿支皮瓣以及这些皮瓣的组合，但关于这些皮瓣在并发症和复发率方面哪种皮瓣更好的文献却很少。
检索的数据库如下：Cochrane 对照试验中心注册库（2000 年 1 月至 2020 年 7 月）、MEDLINE（2000 年 1 月至 2020 年 7 月）和 EMBASE（2000 年 1 月至 2020 年 8 月）。使用的关键词是“压疮”、“皮瓣”、“手术”、“压力性溃疡”，并限制为“人类”和“英语”。主要结局是“总体并发症发生率”和“复发率”。总体并发症进一步分为皮瓣坏死、皮瓣裂开、感染和其他。
最终有 39 篇文章被纳入分析。各种类型的皮瓣在总体并发症、皮瓣裂开、感染、皮瓣坏死和复发率方面存在统计学差异。
我们的研究表明，肌皮瓣的复发率较低，而联合皮瓣的并发症发生率较低。然而，在选择皮瓣来重建缺损时，还应考虑其他各种因素，如供区发病率、初始缺损大小、手术时间、术中失血量、复发时的挽救选择。
