自由设计的带蒂穿支皮瓣结合负压封闭引流术修复臀部压疮的临床效果  

Clinical effect of self-designed pedicled perforator flap combined with vacuum sealing drainage technique in repair of pressure ulcer on buttocks

作　　者：穆泽兰 张键 顾媛 白南[2] 付妍婕[3] Mu Zelan;Zhang Jian;Gu Yuan;Bai Nan;Fu Yanjie(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Medical Cosmetology,Linyi People's Hospital,Linyi 276003,China;Department of Burn and Plastic Surgery,Linyi People's Hospital,Linyi 276003,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261053 [2]临沂市人民医院医学美容科,临沂276003 [3]临沂市人民医院烧伤整形外科,临沂276003

出　　处：《中华医学美学美容杂志》2025年第2期115-119,共5页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：山东省自然科学基金(ZR2021MH338)。

摘　　要：目的探讨自由设计的带蒂穿支皮瓣结合负压封闭引流术(VSD)修复臀部压疮的临床效果。方法回顾性纳入2020年1月至2023年4月临沂市人民医院采用自由设计的带蒂穿支皮瓣结合VSD技术治疗臀部压疮的患者15例,其中男9例,女6例,年龄41~73(57±16)岁,病程12~39 d。清创VSD后,采用自由设计的带蒂穿支皮瓣修复创面,创面较大者供区采用接力皮瓣转移修复,所有创面均一期缝合,VSD引流1周。观察术后皮瓣成活、伤口愈合情况及患者随访情况。结果3例为混合型压疮,12例为溃疡型压疮,创面底部面积3 cm×5 cm~10 cm×15 cm。14例患者术后皮瓣存活良好,切口愈合良好,1例截瘫患者因创面感染较重且基础情况较差,术后出现出血、皮瓣下积血、切口愈合不良,行皮瓣清创修整术,术后10 d愈合出院。手术时间为(123±10)min;出血量为(87±5)ml。术后13例患者获得随访3~24个月,皮瓣血运良好,外形、质地满意,无复发。结论自由设计的带蒂穿支皮瓣结合VSD是修复臀部压疮的有效方法,术中出血量少,手术时间短。Objective To investigate the clinical application and effect of the self-designed pedicled perforator flap combined with vacuum sealing drainage(VSD)for the repair of gluteal pressure ulcers.Methods A retrospective study was performed on 15 patients with gluteal pressure ulcers who were treated with self-designed pedicled perforator flaps combined with VSD in Linyi People's Hospital from January 2020 to April 2023.The cohort included 9 males and 6 females,with ages ranging from 41 to 73(57±16)years,and the duration of the disease ranged from 12 to 39 days.Following debridement surgery in conjunction with VSD treatment,the wounds were repaired with self-designed pedicled perforator flaps.In cases with larger donor areas,relay flaps were utilized.All wounds were closed in the first stage with VSD drainage for one week.Postoperative assessments focused on flap survival,wound healing,and patient follow-up.Results Three cases were mixed pressure ulcers,12 cases were ulcerative pressure ulcers,and the area of the base of the wound ranged from 3 cm×5 cm to 10 cm×15 cm.Among the cohort,14 patients demonstrated favorable outcomes regarding flap survival and incision healing while one paraplegic patient experienced bleeding,subcutaneous congestion and poor incision healing after operation due to severe wound infection and poor fundamentals,and was discharged from the hospital after 10 days of healing post-operation with the flap clearing and repairing.The duration of the operation was(123±10)min,and the intraoperative blood loss was(87±5)ml.A total of 13 cases were followed up for 3 to 24 months with satisfactory results.The flaps demonstrated optimal hematologic performance,satisfactory appearance and texture,and no recurrence of ulcers.Conclusion The combination of self-designed pedicled perforator flap with VSD is an effective method for repairing gluteal pressure ulcers with less intraoperative bleeding and shorter operative time.

关 键 词：褥疮 穿支皮瓣 负压封闭引流 

分 类 号：R622[医药卫生—整形外科]