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

Effects of perforator flaps combined with muscle flaps for repairing grade IV pressure ulcers in ischial tuberosity of elderly patients

目的探讨运用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。方法2014年4月-2017年4月，笔者单位收治9例坐骨结节Ⅳ期压疮老年患者，创面面积5cm×3cm～12cm×7cm，窦道深度6～22cm。入院后，急诊或择期行创面清创术，术后应用持续封闭负压引流技术进行治疗。治疗1～2周后，采用臀下动脉穿支皮瓣＋股二头肌长头肌肌瓣修复4例，臀下动脉穿支皮瓣＋半膜肌肌瓣修复3例，臀下动脉穿支皮瓣＋股薄肌肌瓣修复1例，股深动脉穿支皮瓣＋臀大肌肌瓣修复1例，该例患者术中见股深动脉穿支皮瓣远端约6cm×4cm发绀，遂保留皮瓣近端，将皮瓣远端发绀部分修薄为中厚皮覆盖于肌瓣，余8例患者术中组织瓣均无异常。皮瓣切取面积为7cm×5cm～14cm×12cm，肌瓣切取面积为11cm×4cm～24cm×6cm，供瓣区均直接拉拢缝合。结果术后所有患者移植组织瓣和皮片均存活良好。随访8～35周，所有患者术区外形和质地良好，未见局部溃破或压疮复发。结论穿支皮瓣＋肌瓣是修复老年患者坐骨结节Ⅳ期压疮和减少压疮复发的有效方法。

Objective To explore effects of perforator flaps combined with muscle flaps for repairing grade IV pressure ulcers in ischial tuberosity of elderly patients. Methods Nine elderly patients with grade Ⅳ pressure ulcers in ischial tuberosity were hospitalized in our burn ward from April 2014 to April 2017. Size of wounds ranged from 5 cm× 3 cm to 12 cm ×7 cm, and depth of sinus ranged from 6 to 22 cm. After admission, emergency debridement or debridement in selective time was performed. After debridemerit, the wounds were treated with continuous vacuum assisted closure therapy. After the treatment for 1 to 2 weeks, tissue flaps repair operations were performed. Four patients were repaired with inferior gluteal artery perforator flaps combined with long head of biceps femoris muscle flaps. Three patients were repaired with inferior gluteal artery perforator flaps combined with semimembranous muscle flaps. One patient was repaired with inferior gluteal artery perforator flap combined with gracilis muscle flap. One patient was repaired with femoral profound artery perforator flap combined with gluteus maximus muscle flap, and the distal area of femoral profound artery perforator flap of the patient which showed intraoperative cyanosis of 6 cm×4 cm was thinned to medium thickness skin to cover the muscle flap. The other eight patients showed no abnormality during operation. Size of perforator flaps ranged from 7 cm × 5 cm to 14 cm ×12 cm, and size of muscle flaps ranged from 11 cm ×4 cm to 24 cm× 6 cm. The donor sites of flaps were all sutured directly. Results The tissue flaps and skin graft of all patients survived well after operation. During follow-up of 8 to 35 weeks, operative area of all patients showed good shape and texture, with no local diabrosis or recurrence of pressure ulcers. Conclusions The combination of perforator flaps and muscle flaps is effective in repairing and reducing recurrence of grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients.