股后侧穿支皮瓣接力邻位皮瓣修复骶尾部反复再发压疮13例  

Posterior femoral perforator flap relay adjacent flap in reconstruction of recurrent sacrococcygeal pressure sores:a report of 13 cases

作　　者：刘江涛 王一勇 庄玲玲[1] 林奕锋 黄书润[1] LIU Jiangtao;WANG Yiyong;ZHUANG Lingling;LIN Yifeng;HUANG Shurun(Department of Burns and Plastic Surgery,the 910th Hospital of Joint Service Support Unit of PLA,Quanzhou,Fujian Province 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院烧伤整形科,福建泉州362000

出　　处：《中华显微外科杂志》2024年第5期496-501,共6页Chinese Journal of Microsurgery

基　　金：福建省自然科学基金计划项目(2023J01241)。

摘　　要：目的探讨应用股后侧穿支皮瓣(PFPF)接力邻位皮瓣修复骶尾部反复再发压疮的临床效果。方法采用回顾性观察性研究方法。2019年12月-2023年5月,中国人民解放军联勤保障部队第九一〇医院烧伤整形科收治骶尾部反复再发压疮患者13例,男8例,女5例,年龄42~69岁。所有患者压疮创面分级为Ⅲ~Ⅳ期,其中8例为第2次复发压疮,5例为第3次复发压疮。完善术前准备后,分两期行手术治疗,Ⅰ期行压疮彻底清创术,清创后创面面积为5.0 cm×6.0 cm~15.0 cm×9.0 cm,术后行VSD治疗7 d,Ⅱ期行皮瓣修复术,根据创面位置、大小及创面周缘臀部仅存的正常皮肤组织,利用邻位皮瓣修复骶尾部压疮创面,PFPF接力修复邻位供瓣区创面,邻位皮瓣面积为6.0 cm×7.0 cm~16.0 cm×9.5 cm,PFPF面积为9.0 cm×8.0 cm~18.0 cm×10.0 cm,PFPF采用螺旋桨方式旋转,股后侧供瓣区均直接缝合。术后观察邻位皮瓣及PFPF成活情况、供瓣区创面愈合情况、治愈时间,通过门诊、微信或电话随访皮瓣的外观、质地及压疮复发情况,随访截止时间2024年1月。结果术后13例患者共26块皮瓣均成活,其中1例因术后翻身搬动致邻位皮瓣局部裂开,经再次局部麻醉下缝合后愈合,1例邻位皮瓣下积液、1例PFPF下局部裂开,经换药后均治愈。创面愈合时间16~30 d。随访6~12个月,患者皮瓣外观良好、质地软,表面无破溃,压疮无复发。结论PFPF接力邻位皮瓣修复骶尾部反复再发压疮,可以在臀部正常皮肤组织量少的情况下达到封闭修复创面、皮瓣成活率高、创面愈合好、股后侧供瓣区无需植皮、远期效果恢复好等疗效。Objective To explore the clinical effect of application of a posterior femoral perforator flap(PFPF)relayed an adjacent flap of recipient site in reconstruction of the recurrent pressure sores in sacrococcygeal region.Methods Retrospective observation method was used in this study.From December 2019 to May 2023,13 patients with recurrent pressure sores in sacrococcygeal region were admitted in the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA.The patients were 8 males and 5 females who aged 42-69 years old.All the pressure sores were in GradeⅢ-Ⅳ.Eight patients had pressure sores for a second time and 5 for a third time.After preoperative preparations,the surgical treatment was planned in 2 stages.In the first stage,the pressure sores were thoroughly debrided,and the wounds after debridement were at 5.0 cm×6.0 cm-15.0 cm×9.0 cm in size.After debridement,the wounds were covered by VSD for 7 days.Flap reconstruction of the wounds of pressure sores were performed in the second stage surgery.According to the location and size of the wounds and the remaining normal skin tissue around the wounds,the adjacent flaps were taken to reconstruct the wounds of sacrococcygeal pressure sore.PFPFs were employed to reconstruct the donor site wounds left by the adjacent flap.The sizes of the adjacent flap were 6.0 cm×7.0 cm-16.0 cm×9.5 cm,and the PFPFs were 9.0 cm×8.0 cm-18.0 cm×10.0 cm in size.PFPF was rotated in a manner of propeller.The donor sites of PFPF were directly sutured.After surgery,survival of the adjacent flaps and PFPFs,the wound healing in the donor sites as well as the healing time were observed.The appearance,texture and recurrence of pressure sores of the flap reconstruction sites were observed at outpatient clinic,via WeChat reviews or telephone interviews up to January 2024.Results Twenty-six flaps of 13 patients survived after surgery,inclusive of 1 patient with the adjacent flap partially split due to turn-over and transport of the patient after s

关 键 词：压疮 股后侧穿支皮瓣 骶尾部 修复 显微外科技术 

分 类 号：R622[医药卫生—整形外科]