Borgognone Alessandro, Santi Giancarlo Delli, Baffigo Giulio, Capobianco Serena Vincenza, Goletti Stefania
Operative Unit of Plastic Surgery and Burns, S. Eugenio - C.T.O. Hospital, Rome, Italy.
Operative Unit of Neuro- Urology, S. Eugenio - C.T.O. Hospital, Rome, Italy.
JPRAS Open. 2023 Aug 19;38:91-97. doi: 10.1016/j.jpra.2023.08.002. eCollection 2023 Dec.
This study highlights the effectiveness, in one surgical stage, of two combined local techniques for perineal fistula repair in a patient with spinal cord injury: the " and the " from the inferior gluteal fold. Unlike the traditional , we harvested a ; by definition, this is a flap with a narrow diffuse microvascular supply aimed in our case at shielding the neourethra and substituting the remaining scarred perineum. The urethroplasty technique adopted, the has been based on sculpting two opposing local cutaneous flaps circumscribing the fistulous cutaneous openings. Eventually, the neourethra continuity has been re-established by turning over both flaps and making them meet medially. The dimension and thickness of the " have been considered to prevent any damage to the urethroplasty and at the same time to replace all the debrided scarred perineal tissue. The follow-up confirmed a well-consolidated supple perineal area and a competent neourethra. The " is by definition a random vascular flap nourished through a narrow pedicle, not based on a single perforator but only on a diffuse, spread micro-perforators. When associated with the double ", it represents a possible alternative to achieve satisfactory results for those physical and psychological challenges encountered in the treatment of recurrent urethral fistula of the perineum in a patient with spinal cord injury.
本研究强调了在脊髓损伤患者中，两种联合局部技术在一个手术阶段修复会阴瘘的有效性：即从臀下皱襞处采用的“[此处原文缺失相关技术名称]”和“[此处原文缺失相关技术名称]”。与传统方法不同，我们采用了一种[此处原文缺失相关技术名称]；从定义上讲，这是一种具有狭窄弥散微血管供应的皮瓣，在我们的病例中旨在保护新尿道并替代剩余的瘢痕化会阴组织。所采用的尿道成形术技术，即[此处原文缺失相关技术名称]，是基于雕刻围绕瘘口皮肤开口的两个相对的局部皮瓣。最终，通过翻转两个皮瓣并使其在内侧会合，重新建立了新尿道的连续性。“[此处原文缺失相关技术名称]”的尺寸和厚度被认为既能防止对尿道成形术造成任何损伤，又能同时替代所有清创后的瘢痕化会阴组织。随访证实会阴区域柔软且愈合良好，新尿道功能正常。从定义上讲，“[此处原文缺失相关技术名称]”是一种通过狭窄蒂部供血的随意血管皮瓣，其供血并非基于单一穿支，而是仅基于弥散分布的微小穿支。当与双侧“[此处原文缺失相关技术名称]”联合使用时，它为脊髓损伤患者会阴复发性尿道瘘治疗中遇到的那些生理和心理挑战提供了一种可能获得满意结果的替代方法。
