Zingarelli Enrico M, Perrero Luca, Ghiglione Marco, Panizza Renzo
Department of Plastic and Reconstructive Surgery, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
Department of Spinal Injuries and Neurological Rehabilitation Unit, Borsalino Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
J Orthop Case Rep. 2022 Feb;12(2):38-41. doi: 10.13107/jocr.2022.v12.i02.2656.
Patients affected by spina bifida (SB) can present varying degrees of paralysis, limited mobility, impaired sensation, orthopedic problems and bowel, bladder, and renal impairments. Skin wounds are reported as one of the primary diagnosis associated with hospitalizations in SB affected patients. In young patients, pressure injuries can occur more frequently at the lower limb. A multidisciplinary approach and a proper surgical technique are mandatory to obtain favorable long-term outcomes, in terms of adequate coverage and risk of recurrence.
A Caucasian male 21-year-old wheelchair-bound patient with history of SB was admitted to our department with stage four pressure injury on the medial aspect of knee joint and osteomyelitis. After antibiotic therapy wound preparation and debridement, we covered the pressure sore with a pedicled fasciocutaneous flap harvested from the medial compartment of the thigh. In the distal part, we splitted the fascia from the flap and used it to reconstruct the exposed knee joint. We did not report any complications and no recurrence was observed at 1-year follow-up examination.
In this reported case, the multidisciplinary approach and the surgical technique allowed us to cover the soft-tissue defect around knee joint, reducing morbidity, surgical time, and cost with good long-term outcomes.
患有脊柱裂（SB）的患者可能会出现不同程度的瘫痪、活动受限、感觉受损、骨科问题以及肠道、膀胱和肾脏功能障碍。皮肤伤口被报告为SB患者住院相关的主要诊断之一。在年轻患者中，下肢更容易发生压疮。为了在充分覆盖和复发风险方面获得良好的长期效果，多学科方法和适当的手术技术是必不可少的。
一名21岁的白种男性轮椅患者，有脊柱裂病史，因膝关节内侧四期压疮和骨髓炎入住我科。经过抗生素治疗、伤口准备和清创后，我们用取自大腿内侧间隙的带蒂筋膜皮瓣覆盖压疮。在远端，我们将筋膜从皮瓣上分离下来，用于重建暴露的膝关节。我们未报告任何并发症，在1年的随访检查中未观察到复发。
在本报告病例中，多学科方法和手术技术使我们能够覆盖膝关节周围的软组织缺损，降低发病率、手术时间和成本，并取得良好的长期效果。
