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

曹学新; 张永磊; 赵树青; 张庆; 池征璘

doi:10.3760/cma.j.cn501225-20231017-00115

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

doi: 10.3760/cma.j.cn501225-20231017-00115

1.
德州东城医院手足显微外科，德州　　253000
2.
西安仲德骨科医院修复重建显微外科，西安　　710043

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通讯作者:
池征璘，Email：57699788@qq.com

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出版历程
- 收稿日期: 2023-10-17

Clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers

1.
Department of Hand and Foot Microsurgery, Dezhou Dongcheng Hospital, Dezhou 253000, China
2.
Repair and Reconstruction Microsurgery, Xi'an Zhongde Orthopedic Hospital, Xi'an 710043, China

More Information

Corresponding author: Chi Zhenglin, Email: 57699788@qq.com

摘要

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。
- 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
Abstract: 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 stage Ⅳ ischial tuberosity pressure ulcers. Methods This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial 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 skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.
- 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
曹学新：论文撰写、数据整理、统计分析；张永磊、赵树青、张庆：围手术期管理、数据收集；池征璘：研究指导、文章审阅及修改

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1 模拟修复坐骨结节压疮的股后皮神经营养血管皮瓣和股后肌瓣的设计与切取。1A.皮瓣设计和肌瓣的肌肉解剖示意图；1B.在乳胶灌注的新鲜尸体标本上，模拟皮瓣和肌瓣切取，显露穿支血管

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2 股后肌瓣联合股后皮神经营养血管皮瓣及闭式灌洗治疗患者左侧Ⅳ期坐骨结节压疮的效果。2A.清创前左侧坐骨结节压疮创腔巨大，深达坐骨结节；2B.清创后于左侧股后区设计股二头肌长头肌瓣、半腱肌肌瓣及股后皮神经营养血管皮瓣；2C.术中肌瓣和皮瓣切取及血管蒂显露情况；2D.转移肌瓣填塞坐骨结节创腔并将肌瓣与周围组织缝合术中；2E.分别缝合皮瓣和供瓣区并留置引流管术后即刻外观；2F.术后1年随访，左侧坐骨结节压疮无复发，皮瓣及供区外观良好

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