Foster R D, Anthony J P, Mathes S J, Hoffman W Y
Division of Plastic and Reconstructive Surgery, University of California at San Francisco, USA.
Br J Plast Surg. 1997 Jul;50(5):374-9. doi: 10.1016/s0007-1226(97)90548-8.
The role of wound debridement and flap coverage in treating pressure sores is clearly established. However, criteria and supportive clinical data for specific flap selection and the sequence of flaps for coverage of the ischium remain ill-defined. From 1979-1995, 114 consecutive patients underwent flap coverage of 139 ischial pressure sores. Preoperative risk factors, prior flap history, defect size, flap success, complication rates, and the length of hospitalization were retrospectively evaluated and compared for 112 flaps in 87 patients. Flap success was defined as a completely healed wound. Average follow-up was 10 months (range: 1 month-9 years). Overall, 83% (93/112) of the flaps healed. In the majority of cases (75%, 84/112), wound debridement and flap reconstruction was achieved in a single stage. However, there were significant differences in the healing rates among the various flaps used. The inferior gluteus maximus island flap and the inferior gluteal thigh flap had the highest success rates, 94% (32/34) and 93% (25/27), respectively, while the V-Y hamstring flap and the tensor fascia lata flap had the poorest healing rates, 58% (7/12) and 50% (6/12), respectively. Flap success was not significantly affected by the age of the patient or the prior number of flaps used and preoperative risk factors were equally distributed across all types of flaps. The overall complication rate was 37% (41/112), most commonly from a slight wound edge dehiscence (n = 16) that healed with local wound care within one month postoperatively. Results of this study show that proper flap selection and the appropriate sequence of flap use significantly improve success rates for ischial pressure sore coverage in both the short- and long-term. Based upon flap reliability (successful healing rates), reusability, and the need to preserve as many future flap options as possible, a rationale for flap selection is presented which can be individualized to any patient.
伤口清创和皮瓣覆盖在治疗压疮中的作用已得到明确证实。然而，关于特定皮瓣选择的标准和支持性临床数据以及用于覆盖坐骨的皮瓣顺序仍不明确。1979年至1995年期间，114例连续患者接受了139处坐骨压疮的皮瓣覆盖。对87例患者的112处皮瓣的术前危险因素、既往皮瓣史、缺损大小、皮瓣成功率、并发症发生率和住院时间进行了回顾性评估和比较。皮瓣成功定义为伤口完全愈合。平均随访时间为10个月（范围：1个月至9年）。总体而言，83%（93/112）的皮瓣愈合。在大多数病例（75%，84/112）中，伤口清创和皮瓣重建在一期完成。然而，所使用的各种皮瓣的愈合率存在显著差异。臀大肌下岛状皮瓣和臀下大腿皮瓣的成功率最高，分别为94%（32/34）和93%（25/27），而V-Y腘绳肌皮瓣和阔筋膜张肌皮瓣的愈合率最差，分别为58%（7/12）和50%（6/12）。皮瓣成功不受患者年龄或既往使用皮瓣的次数影响，术前危险因素在所有类型的皮瓣中分布均匀。总体并发症发生率为37%（41/112），最常见的是轻微伤口边缘裂开（n = 16），术后1个月内通过局部伤口护理愈合。本研究结果表明，正确的皮瓣选择和皮瓣使用的适当顺序在短期和长期内均能显著提高坐骨压疮覆盖的成功率。基于皮瓣的可靠性（成功愈合率）、可重复使用性以及尽可能保留更多未来皮瓣选择的需要，提出了一种皮瓣选择的基本原理，可针对任何患者进行个体化。
