摘要
目的探讨股后肌瓣联合股后皮神经营养血管皮瓣及闭式灌洗治疗Ⅳ期坐骨结节压疮的临床效果。方法该研究为回顾性观察性研究。2021年3月—2022年3月,德州东城医院收治15例符合入选标准的Ⅳ期坐骨结节压疮患者,其中男11例、女4例,年龄31~72岁。压疮创面大小为6.0 cm×4.5 cm~10.0 cm×6.0 cm,创腔直径10~14 cm。5例患者合并坐骨结节骨感染。清除病灶后,移植股二头肌长头肌瓣(面积10.0 cm×4.0 cm~18.0 cm×5.0 cm)和半腱肌肌瓣(面积8.0 cm×4.0 cm~15.0 cm×5.0 cm)联合股后皮神经营养血管皮瓣(面积6.5 cm×5.5 cm~10.5 cm×6.5 cm)修复压疮创面,将供瓣区创面直接缝合,于创腔内置管行闭式灌洗2~3周。术后观察肌瓣和皮瓣成活情况、供受区创面愈合情况,随访观察压疮复发情况、皮瓣质地和外观及供受区瘢痕情况。结果15例患者术后所有肌瓣和皮瓣均顺利成活。2例患者术后1周因翻身不当导致受区切口受压裂开,经换药治疗3~4周后愈合;其余患者供受区创面均愈合良好。术后患者均获得随访,随访6~12个月显示,患者压疮均未复发,皮瓣质地、色泽、厚度与受区皮肤相近,供受区仅遗留线性瘢痕。结论采用股后肌瓣联合股后皮神经营养血管皮瓣及闭式灌洗治疗Ⅳ期坐骨结节压疮时,可用组织瓣充分填塞压疮无效腔,治疗后创面愈合好,供受区外观较佳,压疮不易复发。
Objective To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stageⅣischial tuberosity pressure ulcers.Methods This study was a retrospective observational study.From March 2021 to March 2022,15 patients with stageⅣischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital,including 11 males and 4 females,aged 31 to 72 years.The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm,with cavity diameters of 10-14 cm.Five cases were complicated with ischial tuberosity bone infection.After clearing the lesion,the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound.The flap donor area was directly sutured,and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks.The postoperative survival of the muscle flaps and skin flaps,the wound healing of the donor and recipient areas were observed.The recurrence of pressure ulcers,the appearance and texture of flaps,and scar conditions of the donor and recipient areas were followed up.Results All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery.Two patients experienced incisional dehiscence at one week after surgery due to improper turning over,during which the incision in the recipient area was pressed on,and the wounds healed after dressing changes of 3 to 4 weeks;the wounds in the donor and recipient areas healed well in the other patients.All patients received follow-up after surgery.During the follow-up period of 6 to 12 months,none of the patients experienced pressure ulcer recurrence,and the texture,color,and thickness of the sk
作者
曹学新
张永磊
赵树青
张庆
池征璘
Cao Xuexin;Zhang Yonglei;Zhao Shuqing;Zhang Qing;Chi Zhenglin(Department of Hand and Foot Microsurgery,Dezhou Dongcheng Hospital,Dezhou 253000,China;Repair and Reconstruction Microsurgery,Xi'an Zhongde Orthopedic Hospital,Xi'an 710043,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2024年第2期159-164,共6页
Chinese Journal of Burns And Wounds
关键词
压力性溃疡
外科皮瓣
显微外科手术
坐骨结节
股二头肌长头肌瓣
半腱肌肌瓣
股后皮神经营养血管皮瓣
闭式灌洗
Pressure ulcer
Surgical flaps
Microsurgery
Ischial tuberosity
Biceps femoris long head muscle flap
Semitendinosus muscle flap
Posterior femoral cutaneous nerve nutrient vessel flap
Closed lavage
