Fei Y Frances, Welch Kathryn C, Haefner Hope K
Department of Obstetrics and Gynecology, University of Michigan.
Plast Reconstr Surg Glob Open. 2021 Nov 16;9(11):e3939. doi: 10.1097/GOX.0000000000003939. eCollection 2021 Nov.
Patients with stage III hidradenitis suppurativa of the vulva and adjacent areas, unresponsive to other therapies, may require extensive surgeries. These include excision of diseased areas on the buttocks, vulva, groins, and abdomen, followed by delayed skin grafting. Negative pressure wound therapy has been used over grafts, but it can be difficult to maintain a seal when extensive areas have been resected. We present a novel technique to bolster skin grafts for optimal success. A total vulvectomy and resection of the buttocks, groins, and abdomen are first performed for stage III HS, incorporating all diseased tissue. Negative pressure wound therapy is applied and changed on postoperative day 3-4. On postoperative day 7, split-thickness skin grafts are applied. The skin grafts are covered by Adaptic gauze (3M Company, Minn.), cotton, and a layer of Reston foam (3M Company, St. Paul, Minn.) which is cut to fit the size of the wound. Ostomy skin barriers (Hollister Incorporated, Libertyville, Ill.) are placed on the skin surrounding the excised areas. Pediatric Foley catheters are then placed through the ostomy skin barriers and tied together to prevent movement of the bolster. The use of ostomy skin barriers and pediatric Foley catheters to secure bolsters has not previously been described. We demonstrate a well-tolerated technique, using common surgical supplies, to provide consistent uniform pressure over the graft site. This technique also allows for easy bedside dressing change(s) when indicated.
患有外阴及邻近区域Ⅲ期化脓性汗腺炎且对其他治疗无反应的患者可能需要进行广泛的手术。这些手术包括切除臀部、外阴、腹股沟和腹部的病变区域，随后进行延迟植皮。负压伤口治疗已用于植皮，但在切除大面积区域后可能难以保持密封。我们提出一种新技术来支撑皮肤移植以获得最佳效果。对于Ⅲ期化脓性汗腺炎，首先进行全外阴切除术以及臀部、腹股沟和腹部切除术，切除所有病变组织。术后第3 - 4天应用并更换负压伤口治疗。术后第7天，进行中厚皮片移植。皮肤移植片用Adaptic纱布（3M公司，明尼苏达州）、棉花以及一层Reston泡沫（3M公司，明尼苏达州圣保罗）覆盖，Reston泡沫按伤口大小裁剪。造口皮肤屏障（Hollister公司，伊利诺伊州利伯蒂维尔）放置在切除区域周围的皮肤上。然后将小儿Foley导管穿过造口皮肤屏障并系在一起，以防止支撑物移动。此前尚未描述使用造口皮肤屏障和小儿Foley导管来固定支撑物的方法。我们展示了一种耐受性良好的技术，使用常见的手术用品，在移植部位提供持续均匀的压力。该技术在需要时还便于在床边更换敷料。
