股后皮神经营养血管脂肪筋膜瓣联合臀部自由式穿支皮瓣修复Ⅳ期坐骨结节压疮创面的疗效  

Efficacy of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps plus free‑style gluteal perforator flaps in the repair of stage IV sciatic tuberosity pressure ulcers

作　　者：邓如非 黄国能 胡翔天 姜臻宇 邹立津[1] 辛国华[1] 张友来[1] Deng Rufei;Huang Guoneng;Hu Xiangtian;Jiang Zhenyu;Zou Lijin;Xin Guohua;Zhang Youlai(Medical Center of Plastic Surgery for Burns and Wound Repair,First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院烧伤整形与创面修复医学中心,南昌330006

出　　处：《中华创伤杂志》2024年第12期1114-1120,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金地区科学基金项目(81760343);江西省自然科学基金面上项目(20202BABL206072)。

摘　　要：目的探讨股后皮神经营养血管脂肪筋膜瓣联合臀部自由式穿支皮瓣修复Ⅳ期坐骨结节压疮创面的临床效果。方法采用回顾性病例系列研究分析2021年5月至2024年2月南昌大学第一附属医院收治的16例(16处创面)Ⅳ期坐骨结节压疮患者的临床资料,其中男10例,女6例;年龄21~84岁[(58.5±16.5)岁]。其中8例(8处创面)合并坐骨慢性骨髓炎。清创前创面面积2.0 cm×1.5 cm~9.0 cm×7.0 cm。患者均采用分期手术,Ⅰ期手术切除创缘瘢痕、创面坏死组织、滑囊及坐骨慢性骨髓炎病灶,清创后创面面积为4.0 cm×3.0 cm~12.0 cm×8.0 cm,行负压封闭引流(VSD)治疗并完成创面床准备。Ⅱ期手术行股后皮神经营养血管脂肪筋膜瓣翻转填塞创腔后联合臀部自由式穿支皮瓣推进或旋转修复创面,股后皮神经营养血管脂肪筋膜瓣切取面积为9.0 cm×3.5 cm~19.0 cm×10.0 cm,臀部自由式穿支皮瓣切取面积为5.0 cm×4.0 cm~13.0 cm×8.5 cm。记录Ⅱ期手术术中出血量。观察术后股后皮神经营养血管脂肪筋膜瓣和臀部自由式穿支皮瓣成活情况、切口愈合情况。末次随访时观察压疮和骨髓炎有无复发、创面外观情况及供区有无继发功能障碍或畸形。结果患者均获随访6~15个月[(9.4±3.1)个月]。Ⅱ期手术术中出血量为80~300 ml[(162.9±60.6)ml]。术后所有股后皮神经营养血管脂肪筋膜瓣成活良好;1例臀部自由式穿支皮瓣术后1 d远端出现小面积淤紫,经拆除部分缝线后缓解。1例股后皮神经营养血管脂肪筋膜瓣供区创面术后1 d因皮下血肿导致切口缝线撕脱,经床旁行清创缝合+换药后22 d愈合;其余患者切口均愈合良好。末次随访时,压疮和骨髓炎均未复发;创面轻度色素沉着、柔软;股后及臀部供区均未继发功能障碍或畸形。结论采用股后皮神经营养血管脂肪筋膜瓣联合臀部自由式穿支皮瓣修复Ⅳ期坐骨结节压疮创面,具有术中出血少、组织�Objective To explore the clinical efficacy of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps plus free⁃style gluteal perforator flaps in repairing stage IV sciatic tuberosity pressure ulcers.Methods A retrospective case series study was conducted to analyze the clinical data of 16 patients(16 wounds)with stage IV sciatic tuberosity pressure ulcers admitted to First Affiliated Hospital of Nanchang University from May 2021 to February 2024,including 10 males and 6 females,aged 21⁃84 years[(58.5±16.5)years].Among them,8 patients were complicated with chronic osteomyelitis of the ischium at 8 sites.The wound area before debridement ranged from 2.0 cm×1.5 cm to 9.0 cm×7.0 cm.All the patients underwent staged surgery.In phase I surgery,the scar tissue at the wound margin,necrotic tissue,bursa,and chronic 3.0 cm to 12.0 cm×8.0 cm.Negative pressure closure drainage(VSD)was performed and wound bed preparation was completed.In phase II surgery,the posterior femoral cutaneous nerve nutrient vessel adipofascial flaps were flipped,filled into the wound cavity,and then used to repair the wound by advancing and rotating in combination with free⁃style gluteal perforator flap.The area of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps ranged from 9.0 cm×3.5 cm to 19.0 cm×10.0 cm and the area of the free⁃style gluteal perforator flaps ranged from 5.0 cm×4.0 cm to 13.0 cm×8.5 cm.The amount of bleeding in phase II surgery was recorded.The survival and wound healing of the posterior femoral cutaneous nerve nutrient vessel adipofascial flaps and free⁃style gluteal perforator flaps were observed.At the last follow⁃up,recurrence of pressure ulcers and osteomyelitis,external appearance of the wound,and secondary functional impairment and deformity in the donor sites were observed.Results All the patients were followed up for 6⁃15 months[(9.4±3.1)months].The intraoperative bleeding volume in phase II surgery was 80⁃300 ml[(162.9±60.6)ml].All the posterior femoral cutaneo

关 键 词：压力性溃疡 坐骨 外科皮瓣 软组织损伤 显微外科手术 

分 类 号：R622[医药卫生—整形外科]