Repair of pressure ulcers in ischial tuberosity of 15 patients by partially de-epithelialized posterior femoral bilobed flaps
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摘要: 2013年4月—2017年4月,笔者单位收治了15例坐骨结节窦道型压疮患者,其中单侧压疮12例、双侧压疮3例,均有不同程度感染。清创前压疮外口面积1.5 cm×1.0 cm~6.0 cm×5.0 cm。15例患者15处压疮,清创切除窦道壁,行负压封闭引流治疗3~13 d后,单侧压疮应用股后侧双叶皮瓣修复,双侧压疮中一侧应用股后侧双叶皮瓣修复,另一侧应用臀大肌肌皮瓣及局部皮瓣修复,皮瓣面积11.0 cm×7.5 cm~15.0 cm×10.0 cm。去除股后侧双叶皮瓣主瓣远端及边缘表皮,形成真皮复合组织瓣填充深腔,其余部分主瓣覆盖创面,副瓣覆盖主瓣切取区,供瓣区直接拉拢缝合。本组15例患者术后股后侧双叶皮瓣全部成活,其中12处压疮愈合良好;2处因切口部分裂开,经再次缝合后15 d愈合;1处压疮皮瓣下感染,经二次彻底扩创后16 d愈合。术后随访3~18个月,皮瓣质地柔软,外形良好,压疮无复发。Abstract: Fifteen patients with sinus-type pressure ulcer in ischial tuberosity were admitted to our unit from April 2013 to April 2017, including 12 patients of unilateral pressure ulcer and 3 patients of bilateral pressure ulcer. The wounds were with infection of different degrees. The outer wound area of pressure ulcer before debridement ranged from 1.5 cm×1.0 cm to 6.0 cm×5.0 cm. Fifteen patients with 15 pressure ulcers were treated with vacuum sealing drainage for 3 to 13 days after debridement and sinus wall resection. Unilateral pressure ulcer was repaired with posterior femoral bilobed flap. One side of bilateral pressure ulcer was repaired with posterior femoral bilobed flap, and the other side was repaired with gluteus maximus muscle flap combined with local flap. The size of flaps ranged from 11.0 cm×7.5 cm to 15.0 cm×10.0 cm. Epidermis of the distal part and edge of the main flap was removed to make complex dermal tissue flap to fill the deep cavity. The other part of the main flap was applied to cover wound, and another flap of the bilobed flap was applied to cover the donor site where main flap was resected. The donor sites were sutured directly. The posterior femoral bilobed flaps in 15 patients survived after operation. Pressure ulcers of 12 patients were healed well. Incision of 2 patients ruptured and healed 15 days after second sewing. One pressure ulcer with infection under the flap healed on 16 days post second completely debridement. During follow-up of 3 to 18 months, flaps were with soft texture, good appearance, and no recurrence.
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Key words:
- Pressure ulcer /
- Surgical flaps /
- Ischial tuberosity /
- Bilobed flap
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