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

Cao Xuexin; Zhang Yonglei; Zhao Shuqing; Zhang Qing; Chi Zhenglin

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

Volume 40 Issue 2

Feb. 2024

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(2): 159-164

Cao XX,Zhang YL,Zhao SQ,et al.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[J].Chin J Burns Wounds,2024,40(2):159-164.DOI: 10.3760/cma.j.cn501225-20231017-00115.

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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

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

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

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Corresponding author: Chi Zhenglin, Email: 57699788@qq.com
Received Date: 2023-10-17

Abstract

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

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References

[1]	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.
[2]	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.
[3]	陈华,高磊,程景波,等.负压封闭引流下骨水泥联合股后带蒂肌皮瓣移植治疗坐骨结节Ⅳ期压疮的疗效分析[J].中国美容整形外科杂志,2022,33(6):350-352,362.DOI: 10.3969/j.issn.1673-7040.2022.06.010.
[4]	张晓启,栾涛,侯雨杉,等.Ⅳ期褥疮综合治疗的方法与效果[J].武警医学,2021,32(3):209-212.DOI: 10.3969/j.issn.1004-3594.2021.03.007.
[5]	林炳远,郭峭峰,黄凯,等.股薄肌肌瓣治疗老年人Ⅲ、Ⅳ度坐骨结节褥疮的疗效分析[J].中华老年医学杂志,2016,35(9):982-985.DOI: 10.3760/cma.j.issn.0254-9026.2016.09.015.
[6]	纪赓,李翠,陈琳,等.臀大肌肌瓣结合皮瓣治疗褥疮合并坐骨结节囊肿[J].组织工程与重建外科杂志,2020,16(5):378-380.DOI: 10.3969/j.issn.1673-0364.2020.05.007.
[7]	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.
[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]	侯春林,顾玉东.皮瓣外科学[M].3版.上海:上海科学技术出版社,2019:620-622.
[10]	林炳远,郭峭峰,黄凯,等.半腱肌肌瓣修复坐骨结节难治性褥疮21例[J].浙江实用医学,2014,19(6):417-418,458.DOI: 10.16794/j.cnki.cn33-1207/r.2014.06.013.
[11]	于扬,余扬,乔星,等.股二头肌长头肌皮瓣修复坐骨结节处深度褥疮的临床疗效[J].新疆医学,2020,50(6):597-600.
[12]	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.
[13]	邓如非,龙露瑶,陈燕微,等.基于窦道情况及皮肤软组织缺损范围的坐骨结节压疮临床修复策略[J].中华烧伤与创面修复杂志,2024,40(1):64-71.DOI: 10.3760/cma.j.cn501225-20231114-00194.
[14]	周孝亮,涂家金,叶华,等.岛状股后复合组织瓣修复坐骨结节及大转子区窦腔型压疮的临床效果[J].中华烧伤与创面修复杂志,2023,39(1):65-70.DOI: 10.3760/cma.j.cn501225-20220420-00148.
[15]	陈王浩男,张明月,陶科融,等.筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面疗效观察[J].中国修复重建外科杂志,2023,37(4):478-481.DOI: 10.7507/1002-1892.202301035.
[16]	杜伟力,沈余明,胡骁骅,等.供瓣区美学修复方法的探讨[J].中华烧伤杂志,2020,36(2):97-105.DOI: 10.3760/cma.j.issn.1009-2587.2020.02.004.
[17]	刘飞.负压创面治疗技术治疗Ⅲ-Ⅳ度褥疮的临床应用[J].中国伤残医学,2020,28(20):49-50.DOI: 10.13214/j.cnki.cjotadm.2020.20.032.
[18]	冯宇韬,杨澜.创面负压治疗技术对减少Ⅲ~Ⅳ度褥疮患者创面感染的效果[J].临床医学研究与实践,2022,7(33):79-82.DOI: 10.19347/j.cnki.2096-1413.202233021.
[19]	王欣,梁尊鸿,黄阳君,等.多部位难愈性压疮的个体化序贯性治疗[J/CD].中华损伤与修复杂志(电子版),2019,14(4):300-302.DOI: 10.3877/cma.j.issn.1673-9450.2019.04.012.
[20]	汪赛,杨帆,郑梁,等.臀骶周围深度压疮的临床分型及手术治疗策略[J].中国美容整形外科杂志,2023,34(3):133-136.DOI: 10.3969/j.issn.1673-7040.2023.03.002.
[21]	苏卫国,李德平,邢培朋,等.穿支皮瓣联合肌瓣修复老年患者坐骨结节Ⅳ期压疮的效果[J].中华烧伤杂志,2017,33(9):545-549.DOI: 10.3760/cma.j.issn.1009-2587.2017.09.004.
[22]	吴鹏,彭京梁,刘荣朋,等.负压创面治疗技术联合皮瓣分期修复臀股部多发Ⅳ期压疮[J].中国美容医学,2020,29(12):87-89,101.

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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

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

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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

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