Department of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Guangdong 518172, China; Department of Wound Repair, Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, Guangdong 518055, China.
Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, China.
J Plast Reconstr Aesthet Surg. 2024 Jul;94:238-246. doi: 10.1016/j.bjps.2023.03.014. Epub 2023 Apr 18.
Previous reports on the treatment of sacral and ischial pressure injuries have not provided clear algorithms for surgical therapies. The objective of this study was to establish a reconstruction algorithm to guide the selection of an ideal free-style perforator flap that can be tailored to the defect in question.
We used 23 perforator flaps to reconstruct 14 sacral and 8 ischial defects in 22 patients over 5 years. A reconstruction algorithm system was developed based on the anatomical features of the perforator vessels (diameter, D; pulsatility [++∼+++], P) and their position in the skin island (DPD) (ie, D+P+DPD). A perforator-based propeller flap was applied as the first-line choice; if this plan was not feasible, we applied an altered V-Y advancement model or another second-choice technique.
All flaps survived, and only 1 patient experienced partial wound dehiscence, which healed by secondary intention. After an average follow-up period of 11.2 months, no patient experienced recurrence or infection.
Free-style perforator flap selection is determined by pressure injury and the desired advantage of a specific approach. The use of free-style perforator-based propeller flaps allows a surgeon to transfer healthy tissue into the defect, shifts the suture line away from the bony prominence, and preserves additional future donor sites. In cases where unexpected variations are encountered, the V-Y advancement model or another technique can be used. The simplified surgical algorithm (D+P+DPD) can provide versatility and reliability, achieve a durable, natural esthetic outcome, and minimize injuries to future donor sites.
先前关于骶尾部和坐骨压力性损伤治疗的报告并未为手术治疗提供明确的算法。本研究的目的是建立一种重建算法，以指导选择理想的自由风格穿支皮瓣，使其能够适应特定的缺损。
我们在 5 年内使用 23 个穿支皮瓣重建了 22 例患者的 14 个骶尾部和 8 个坐骨缺损。根据穿支血管的解剖特征（直径，D；搏动性[++∼+++]，P）及其在皮岛中的位置（DPD）（即 D+P+DPD），开发了一种重建算法系统。基于穿支的推进瓣被用作首选方案；如果该计划不可行，则应用改良的 V-Y 推进模型或另一种第二选择技术。
所有皮瓣均存活，仅有 1 例患者出现部分伤口裂开，通过二期愈合。平均随访 11.2 个月后，无患者出现复发或感染。
自由风格穿支皮瓣的选择取决于压力性损伤和特定方法的预期优势。使用自由风格穿支皮瓣推进瓣可以使外科医生将健康组织转移到缺损部位，将缝合线从骨突移位，并保留更多未来的供区。如果遇到意外的变异，可以使用 V-Y 推进模型或另一种技术。简化的手术算法（D+P+DPD）可以提供多功能性和可靠性，实现持久、自然美观的效果，并最大限度地减少对未来供区的损伤。
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