基于动脉穿支的双叶皮瓣在4期压疮治疗中的应用效果  

Clinical efficacy of perforator-based bilobed flaps in treatment of stage 4 pressure ulcers

作　　者：吴杭庆 张希龙 王涛[1] 丁佳吉 李松涛 Wu Hangqing;Zhang Xiong;Wang Tao;Ding Jiaji;Li Songtao(Department of Burns and Plastic Surgery and Wound Repair,Xuzhou First People's Hospital,Xuzhou 221116,China)

机构地区：[1]徐州市第一人民医院烧伤整形与创面修复科,徐州221116

出　　处：《中华医学美学美容杂志》2025年第1期42-46,共5页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：徐州市卫生健康委青年医学科技创新项目(XWKYSL20210223)。

摘　　要：目的:探讨基于动脉穿支的双叶皮瓣在4期压疮治疗中的应用效果。方法:本研究为回顾性观察性研究。回顾性纳入2021年8月至2023年5月徐州市第一人民医院烧伤整形与创面修复科收治臀部4期压疮患者29例,男21例,女8例,年龄12~82(61.3±15.7)岁。对于坐骨结节压疮患者,清创后利用基于股深动脉第1穿支的股后双叶皮瓣联合小块臀大肌肌瓣进行修复;对于骶尾部压疮患者,清创后利用基于臀上或臀下动脉穿支的双叶皮瓣进行修复。术后随访2~36个月,观察皮瓣成活情况及并发症发生情况。结果:29例患者双叶皮瓣均无需切断蒂部皮肤和皮下组织,也不需要分离穿支血管,均达到良好的旋转及覆盖效果。26例患者皮瓣均一期愈合,术后2周顺利拆线;3例患者皮瓣因术后受压导致局部切口裂开及皮缘发黑坏死,经清创换药治疗2周后愈合。术后随访2~36个月,所有患者压疮无复发,皮瓣均成活良好,质地柔软、弹性好、血运良好,术区仅遗留线性瘢痕,无其他严重并发症发生。结论:基于动脉穿支设计的双叶皮瓣修复4期压疮临床效果良好。Objective To investigate the clinical efficacy of perforator-based bilobed flaps in the treatment of stage 4 pressure ulcers.Methods This retrospective observational study included 29 patients(21 males,8 females)with stage 4 pressure ulcers admitted to the Department of Burn and Plastic Surgery and Wound Repair at Xuzhou First People's Hospital from August 2021 to May 2023.The patients'ages ranged from 12 to 82(61.3±15.7)years.For ischial tuberosity pressure ulcers,reconstruction was performed using a posterior femoral bilobed flap based on the first perforator of the deep femoral artery,combined with a small gluteus maximus muscle flap.Sacrococcygeal pressure ulcers were repaired using a bilobed flap based on the superior or inferior gluteal artery perforator.Post-operative follow-up lasted for 2-36 months,during which flap survival and complications were assessed.Results All the 29 bilobed flaps were successfully rotated and provided for adequate coverage without the need for pedicle division or perforator vessel dissection.Primary healing was achieved in 26 cases,with suture removal occurring two weeks post-operatively.Three patients experienced partial wound dehiscence and marginal necrosis due to post-operative pressure,which healed after two weeks of debridement and dressing changes.During follow-up for 2-36 months,no pressure ulcer recurrence was observed.The flaps demonstrated excellent survival,with soft texture,good elasticity,and adequate blood supply.The donor sites healed with only linear scars,and no severe complications were reported.Conclusion Bilobed flaps based on artery perforators demonstrate excellent clinical outcomes in the treatment of stage 4 pressure ulcers.

关 键 词：褥疮 双叶皮瓣 外科皮瓣 动脉穿支 

分 类 号：R632.1[医药卫生—外科学]