Clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter

Zhou Xiaoliang; Tu Jiajin; Ye Hua; Wang Xianlin; Sun Junfeng; Long Liyun; Ding Yumei

doi:10.3760/cma.j.cn501225-20220420-00148

Volume 39 Issue 1

Jan. 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(1): 65-70

Zhou XL,Tu JJ,Ye H,et al.Clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter[J].Chin J Burns Wounds,2023,39(1):65-70.DOI: 10.3760/cma.j.cn501225-20220420-00148.

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Clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter

doi: 10.3760/cma.j.cn501225-20220420-00148

Department of Burns and Plastic Surgery, Ganzhou People's Hospital, Ganzhou 341000, China

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Ganzhou Guiding Science and Technology Plan GZ2020ZSF167

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Corresponding author: Tu Jiajin, Email: m18007079751@163.com
Received Date: 2022-04-20

Abstract

Abstract

Objective To explore the clinical effects of island posterior femoral composite tissue flaps in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter. Methods The retrospective observational study was conducted. From December 2018 to December 2021, 23 patients with sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter who met the inclusion criteria were admitted to Ganzhou People's Hospital, including 16 males and 7 females, aged 45 to 86 years. The size of pressure ulcers in ischial tuberosity ranged from 1.5 cm×1.0 cm to 8.0 cm×5.0 cm, and the size of pressure ulcers in greater trochanter ranged from 4.0 cm×3.0 cm to 20.0 cm×10.0 cm before debridement. After treatment of underlying diseases, debridement and vacuum sealing drainage for 5 to 14 days were performed. All the wounds were repaired by island posterior femoral composite tissue flaps, with area of 4.5 cm×3.0 cm-24.0 cm×12.0 cm, pedicle width of 3-5 cm, pedicle length of 5-8 cm, and rotation radius of 30-40 cm. Most of the donor site wounds were sutured directly, and only 4 donor site wounds were repaired by intermediate thickness skin graft from the contralateral thigh. The survival of composite tissue flaps, wound healing of the donor and recipient sites and the complications were observed. The recurrence of pressure ulcers, and the appearance and texture of flaps were observed during follow-up. Results A total of 32 wounds in 23 patients were repaired by island posterior femoral composite tissue flaps (including 3 fascio subcutaneous flaps, 24 fascial flaps+fascio subcutaneous flaps, 2 fascial flaps+fascial dermal flaps, 2 fascial flaps+fascio subcutaneous flaps+femoral biceps flaps, and one fascial flap+fascio subcutaneous flap+gracilis muscle flap). Among them, 31 composite tissue flaps survived well, and a small portion of necrosis occurred in one fascial flap+fascio subcutaneous flap post surgery. The survival rate of composite tissue flap post surgery was 96.9% (31/32). Twenty-nine wounds in the recipient sites were healed, and 2 wounds were torn at the flap pedicle due to improper postural changes, and healed one week after bedside debridement. One wound was partially necrotic due to the flap bruising, and healed 10 days after re-debridement. Thirty-one wounds in the donor sites (including 4 skin graft areas) were healed, and one wound in the donor site was torn due to improper handling at discharge, and healed 15 days after re-debridement and suture. The complication rate was 12.5% (4/32), mainly the incision dehiscence of the flap pedicle and the donor sites (3 wounds), followed by venous congestion at the distal end of flap (one wound). During the follow-up of 3 to 24 months, the pressure ulcers did not recur and the flaps had good appearance and soft texture. Conclusions The island posterior femoral composite tissue flaps has good blood circulation, large rotation radius, and sufficient tissue volume. It has a high survival rate, good wound healing, low skin grafting rate in the donor site, few postoperative complications, and good long-term effect in the repair of sinus cavity pressure ulcers in the areas of ischial tuberosity and greater trochanter.
- Pressure ulcer,
- Ischium,
- Surgical flaps,
- Wound repair,
- Composite tissue flaps,
- Greater trochanter

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References

[1]	KottnerJ, CuddiganJ, CarvilleK, et al. Prevention and treatment of pressure ulcers/injuries: the protocol for the second update of the international Clinical Practice Guideline 2019[J]. J Tissue Viability, 2019, 28(2): 51-58. DOI: 10.1016/j.jtv.2019.01.001.
[2]	KanjLF, WilkingSV, PhillipsTJ. Pressure ulcers[J]. J Am Acad Dermatol, 1998, 38(4):517-536; quiz 537-538. DOI: 10.1016/s0190-9622(98)70113-6.
[3]	MunozN, PosthauerME. Nutrition strategies for pressure injury management: implementing the 2019 international Clinical Practice Guideline[J].Nutr Clin Pract,2022,37(3):567-582.DOI: 10.1002/ncp.10762.
[4]	刘毅,张绪生,张诚,等.褥疮的临床分型及手术治疗原则[J].中国修复重建外科杂志,2007,21(9):932-936.
[5]	刘毅,张鲜英,肖斌,等.17例窦道型压疮的临床特点及处理体会[J].中国修复重建外科杂志,2014,28(8):981-984. DOI: 10.7507/1002-1892.20140216.
[6]	徐永清,何晓清,范新宇,等.臀部不同部位压疮治疗方法的选择[J].中华显微外科杂志,2021,44(3):255-260. DOI: 10.3760/cma.j.cn441206-20201028-00368.
[7]	ArikrishnanD, BalakrishnanTM, JanardhanamJ. Pedicled chimeric perforator flap based on inferior gluteal vessel axis for the reconstruction of stage-four primary ischial pressure sores-a new design[J]. Indian J Plast Surg, 2021,54(2): 177-185. DOI: 10.1055/s-0041-1729505.
[8]	刘本全,董德升,史明艳,等.En bloc切除清创联合臀大肌肌瓣治疗坐骨结节压疮合并慢性骨髓炎的临床效果[J].中华烧伤与创面修复杂志,2022,38(4):363-368.DOI: 10.3760/cma.j.cn501120-20210122-00032.
[9]	张修航,高欣欣,陈欣欣,等.基于组织病理类型的坐骨结节压力性损伤临床修复策略[J].中华烧伤杂志,2019,35(4):261-265. DOI: 10.3760/cma.j.issn.1009-2587.2019.04.005.
[10]	KimJH,KwonHJ,MoonSH,et al.Trochanteric area reconstruction with free flap using perforators as recipients: an alternative and effective option[J].Microsurgery,2020,40(1):32-37.DOI: 10.1002/micr.30424.
[11]	徐承新,刘毅,陈黎明,等.臀部筋膜脂肪瓣修复坐骨结节和大转子复发性窦道型压疮[J].中国修复重建外科杂志,2020,34(10):1354-1355.DOI: 10.7507/1002-1892.202003071.
[12]	冯光,郝岱峰,张新健,等.坐骨结节压力性损伤的分型及修复策略[J/CD].中华损伤与修复杂志:电子版,2019,14(5): 339-343.DOI: 10.3877/cma.j.issn.1673-9450.2019.05.004.
[13]	侯春林,顾玉东.皮瓣外科学[M].2版.上海:上海科学技术出版社,2013:587-590.
[14]	王剑利,王根,赵刚,等.游离股后侧穿支动脉皮瓣的解剖学研究及临床应用[J].中华显微外科杂志,2013,36(1):7-10.DOI: 10.3760/cma.j.issn.1001-2036.2013.01.003.
[15]	LiXC,CuiJL,MaharjanS,et al.Clinical application and the free posterior thigh perforator flap[J].Ann Plast Surg,2017,78(5):526-532.DOI: 10.1097/SAP.0000000000000920.
[16]	AlganS, TanO. Profunda femoris artery perforator flaps: a detailed anatomical study[J]. J Plast Surg Hand Surg,2020,54(6): 377-381. DOI: 10.1080/2000656X.2020.1801456.
[17]	周晔,祝庆海,侯辰兴,等.股深动脉穿支皮瓣的解剖学特点及其在口腔颌面部缺损修复中的应用[J].中华口腔医学杂志,2022,57(6):604-610. DOI: 10.3760/cma.j.cn112144-20220321-00122.
[18]	BoyceMK,MettTR,IpaktchiR,et al.Flap coverage using the posterior gluteal thigh flap[J].Oper Orthop Traumatol,2018,30(4):245-252.DOI: 10.1007/s00064-018-0546-8.
[19]	XieY,ZhuangYH,XueL,et al.A composite gluteofemoral flap for reconstruction of large pressure sores over the sacrococcygeal region[J].J Plast Reconstr Aesthet Surg,2015,68(12):1733-1742.DOI: 10.1016/j.bjps.2015.08.016.
[20]	侯春林,李晓华,刘岩,等.以臀下动脉股后皮支为蒂的股后筋膜皮瓣治疗臀骶部褥疮[J].中华显微外科杂志,1995,18(2):114-115. DOI: 10.3760/cma.j.issn.1001-2036.1995.02.121.
[21]	王君,潘云川,徐家钦,等.双侧臀部旋转皮瓣修复骶尾部巨大压疮52例[J].中华烧伤杂志,2017,33(12):775-777. DOI: 10.3760/cma.j.issn.1009-2587.2017.12.011.
[22]	孙佳琳, 郭鹏飞, 崔正军, 等. 臀上动脉穿支接力皮瓣修复骶尾部压疮的临床效果[J]. 中华烧伤杂志,2020,36(8): 726-729. DOI: 10.3760/cma.j.cn501120-20190607-00265.
[23]	曹世坤,余道江,安璐,等.自由式穿支皮瓣在臀部压疮修复中的应用[J].中华解剖与临床杂志,2020,25(4):365-370. DOI: 10.3760/cma.j.cn101202-20200130-00023.
[24]	宋子卫,林舟丹,何少康. 阔筋膜张肌肌皮瓣移植治疗大转子部压疮的疗效[J].临床骨科杂志, 2017, 20(1): 69-70. DOI: 10.3969/j.issn.1008-0287.2017.01.031.
[25]	陈黎明,刘毅,张诚,等. 改良的阔筋膜张肌肌皮瓣修复大转子创面[J].中国美容医学, 2019, 28(4): 17-19.
[26]	孙晓晨,刘毅,陈黎明. 臀大肌为蒂的“风筝”肌皮瓣修复坐骨结节压疮[J].中国美容整形外科杂志,2020,31(7): 400-401,414. DOI: 10.3969/j.issn.1673-7040.2020.07.005.
[27]	ChouCY, SunYS, ShihYJ, et al. A descriptive, retrospective study of using an oblique downward-design gluteus maximus myocutaneous flap for reconstruction of ischial pressure ulcers[J]. Ostomy Wound Manage,2018,64(3): 40-44.
[28]	MohanAT, ZhuL, SurYJ, et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs: transverse, vertical, and s-shaped profunda artery perforator flaps[J]. Plast Reconstr Surg,2017,139(4): 834e-845e. DOI: 10.1097/PRS.0000000000003224.
[29]	BoissiereF, GandolfiS, RiotS, et al. Flap venous congestion and salvage techniques: a systematic literature review[J]. Plast Reconstr Surg Glob Open,2021,9(1): e3327. DOI: 10.1097/GOX.0000000000003327.
[30]	AndrianasoloJ, FerryT, BoucherF, et al. Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy[J]. BMC Infect Dis,2018,18(1): 166. DOI: 10.1186/s12879-018-3076-y.
[31]	沈运彪, 夏懋, 柯海文, 等. 清创联合皮瓣转移“两步法”治疗4期压疮39例[J]. 中华烧伤杂志,2020,36(9): 870-872. DOI: 10.3760/cma.j.cn501120-20190729-00318.
[32]	朱雄翔,胡大海,郑朝,等. 多发性压力性溃疡的外科治疗[J].中华烧伤杂志,2008,24(1): 6-8. DOI: 10.3760/cma.j.issn.1009-2587.2008.01.003.
[33]	黄兆伦,黄晓栋,万里,等. 持续双负压微压力引流联合重组人表皮生长因子在压疮皮瓣修复术后的应用效果[J].中国现代手术学杂志,2021,25(4): 284-288. DOI: 10.16260/j.cnki.1009-2188.2021.04.010.
[34]	刘衍松,伊力扎提·伊力哈木,曹天勇,等. 术后封闭负压引流在臀部压疮修复中的应用[J].吉林医学, 2019, 40(11): 2615-2616. DOI: 10.3969/j.issn.1004-0412.2019.11.084.
[35]	储国平,吕国忠,朱宇刚,等. 部分去表皮的股后侧双叶皮瓣修复坐骨结节压疮15例[J].中华烧伤杂志,2018,34(8): 559-561. DOI: 10.3760/cma.j.issn.1009-2587.2018.08.015.