摘要
目的探讨应用岛状股后复合组织瓣修复坐骨结节及大转子区窦腔型压疮的临床效果。方法采用回顾性观察性研究方法。2018年12月—2021年12月,赣州市人民医院收治23例符合入选标准的坐骨结节及大转子区窦腔型压疮患者,其中男16例、女7例,年龄45~86岁。清创前坐骨结节压疮大小为1.5 cm×1.0 cm~8.0 cm×5.0 cm,大转子区压疮大小为4.0 cm×3.0 cm~20.0 cm×10.0 cm。治疗基础疾病后,行清创+负压封闭引流5~14 d。所有创面均采用岛状股后复合组织瓣转移修复,面积为4.5 cm×3.0 cm~24.0 cm×12.0 cm,蒂宽3~5 cm,蒂长5~8 cm,旋转半径30~40 cm。将大部分供区创面直接缝合,仅对4个供区创面采用对侧大腿外侧中厚皮片修复。术后观察复合组织瓣成活情况、供受区创面愈合情况及并发症发生情况,随访压疮复发情况以及皮瓣的外观和质地。结果23例患者共32个创面采用岛状股后复合组织瓣(筋膜皮下瓣3个、筋膜皮瓣+筋膜皮下瓣24个、筋膜皮瓣+筋膜真皮瓣2个、筋膜皮瓣+筋膜皮下瓣+股二头肌肌瓣2个、筋膜皮瓣+筋膜皮下瓣+股薄肌肌瓣1个)修复。术后31个复合组织瓣存活良好,1个筋膜皮瓣+筋膜皮下瓣远端少部分坏死,成活率为96.9%(31/32)。术后29个受区创面愈合;2个创面因患者翻身不当致皮瓣蒂部撕裂,床旁清创后1周愈合;1个创面因皮瓣淤紫致少部分坏死,再次清创后10 d愈合。31个供区(含4个植皮区)创面愈合,1个供区创面因出院时搬运不当而撕裂,再次清创缝合后15 d愈合。并发症发生率为12.5%(4/32),以皮瓣蒂部及供区切口裂开为主(3个),皮瓣远端淤血次之(1个)。随访3~24个月,患者压疮均未复发,皮瓣外观好、质地柔软。结论岛状股后复合组织瓣血运好、旋转半径大、组织量足,修复坐骨结节及大转子区窦腔型压疮术后成活率高、创面愈合好、供区创面植皮率低、术后并发症少、远期疗效佳。
Objective To explore the clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter.Methods The retrospective observational study was conducted.From December 2018 to December 2021,23 patients with sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter who met the inclusion criteria were admitted to Ganzhou People's Hospital,including 16 males and 7 females,aged 45 to 86 years.The size of pressure ulcers in ischial tuberosity ranged from 1.5 cm×1.0 cm to 8.0 cm×5.0 cm,and the size of pressure ulcers in greater trochanter ranged from 4.0 cm×3.0 cm to 20.0 cm×10.0 cm before debridement.After treatment of underlying diseases,debridement and vacuum sealing drainage for 5 to 14 days were performed.All the wounds were repaired by island posterior femoral composite tissue flaps,with area of 4.5 cm×3.0 cm-24.0 cm×12.0 cm,pedicle width of 3-5 cm,pedicle length of 5-8 cm,and rotation radius of 30-40 cm.Most of the donor site wounds were sutured directly,and only 4 donor site wounds were repaired by intermediate thickness skin graft from the contralateral thigh.The survival of composite tissue flaps,wound healing of the donor and recipient sites and the complications were observed.The recurrence of pressure ulcers,and the appearance and texture of flaps were observed during follow-up.Results A total of 32 wounds in 23 patients were repaired by island posterior femoral composite tissue flaps(including 3 fascio subcutaneous flaps,24 fascial flaps+fascio subcutaneous flaps,2 fascial flaps+fascial dermal flaps,2 fascial flaps+fascio subcutaneous flaps+femoral biceps flaps,and one fascial flap+fascio subcutaneous flap+gracilis muscle flap).Among them,31 composite tissue flaps survived well,and a small portion of necrosis occurred in one fascial flap+fascio subcutaneous flap post surgery.The survival rate of composite tissue flap post surgery was 96.9%(31/32).Twenty-nine wounds in t
作者
周孝亮
涂家金
叶华
汪显林
孙俊锋
龙丽芸
丁玉梅
Zhou Xiaoliang;Tu Jiajin;Ye Hua;Wang Xianlin;Sun Junfeng;Long Liyun;Ding Yumei(Department of Burns and Plastic Surgery,Ganzhou People's Hospital,Ganzhou 341000,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2023年第1期65-70,共6页
Chinese Journal of Burns And Wounds
基金
赣州市指导性科技计划(GZ2020ZSF167)。
关键词
压力性溃疡
坐骨
外科皮瓣
创面修复
复合组织瓣
大转子
Pressure ulcer
Ischium
Surgical flaps
Wound repair
Composite tissue flaps
Greater trochanter
