Özkan Burak, Albayati Abbas, Tatar Burak Ergün, Uysal Cagri Ahmet
Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey.
Department of Plastic Surgery, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Microsurgery. 2023 Mar;43(3):229-237. doi: 10.1002/micr.30973. Epub 2022 Oct 7.
Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs.
A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width.
A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months).
Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.
骶骨压疮重建术在整形外科实践中经常应用。尽管穿支皮瓣经常被使用，但患者中复发并不少见。因此，在重建过程中尽可能少地使用面积至关重要。因此，我们旨在描述一种数学上标准化的双叶穿支皮瓣设计，用于骶骨压疮重建，其肢体之间具有一定的比例和角度关系。
本报告共纳入17例患者（5例女性/12例男性）。患者的平均年龄为50.4岁（范围为32至79岁）。纳入报告的为3-4级骶骨压疮患者。排除有1-2级骶骨溃疡或其他部位压疮的患者。缺损大小范围为8×14cm至5×16cm。对于骶骨区域的溃疡，我们使用了数学上标准化的双叶皮瓣。根据穿支区域到缺损远端外侧边界的距离，皮瓣第一肢体的长度计划垂直定向90°。第一肢体的宽度保持与缺损长度相等。皮瓣第二肢体的方向根据第一肢体水平设计为90度。因此，第二肢体的长度计算为第一肢体宽度的一半，第二肢体的宽度计算为第一肢体宽度的3/4。
共掀起10个基于臀上动脉穿支的皮瓣，7个皮瓣由臀下动脉穿支供血。皮瓣第一肢体的平均大小为14.7×7.2cm（范围为8至20×6至13cm）。皮瓣第二肢体的平均大小为6.7×5.3cm（范围为5至12×4至8cm）。缺损的平均大小为10.5×7.3cm（范围为8至14×5至16）。平均旋转角度为91.7°（范围为90至100）。术后早期，3例患者检测到血肿，1例患者进行了血肿清除，导致伤口裂开。1例患者出现皮瓣尖端坏死，经伤口护理愈合。未出现皮瓣完全坏死。随访期间未发现晚期复发。平均随访时间为13.1个月（范围为4至24个月）。
对于中到大型骶骨压疮缺损，单侧标准化双叶穿支皮瓣可可靠地作为首选。
