[股后肌皮瓣联合股后皮神经营养血管皮瓣和闭合灌洗治疗Ⅳ期峡部结节性压疮的临床疗效]。

X X Cao, Y L Zhang, S Q Zhao, Q Zhang, Z L Chi
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引用次数: 0

摘要

目的探讨股后肌皮瓣联合股后皮神经营养血管瓣和闭合灌洗治疗Ⅳ期峡部结节性压疮的临床疗效。研究方法本研究为回顾性观察研究。2021年3月至2022年3月,德州市东城医院收治了15例符合纳入标准的Ⅳ期峡部结节性压疮患者,其中男性11例,女性4例,年龄31至72岁。压疮伤口大小为 6.0 cm×4.5 cm 至 10.0 cm×6.0 cm,空腔直径为 10-14 cm。其中 5 例并发骶骨结节骨感染。清除病灶后,移植面积为 10.0 cm×4.0 cm-18.0 cm×5.0 cm 的股二头肌长头肌皮瓣和面积为 8.0 cm×4.0 cm-15.0 cm×5.0 cm 的半腱肌皮瓣,结合面积为 6.5 cm×5.5 cm-10.5 cm×6.5 cm 的股后皮神经营养血管皮瓣,修复压疮创面。皮瓣供区直接缝合,伤口腔内插管封闭灌洗 2-3 周。术后观察了肌肉瓣和皮瓣的存活率,供区和受区的伤口愈合情况。对褥疮的复发、皮瓣的外观和质地、供皮区和受皮区的瘢痕情况进行随访。结果15 名患者的所有肌肉瓣和皮瓣均在术后成功存活。两名患者在术后一周出现切口裂开,原因是翻身不当,受区切口受到压迫,伤口在换药 3 至 4 周后愈合;其他患者供区和受区伤口愈合良好。所有患者在术后都接受了随访。在 6 至 12 个月的随访期间,没有一名患者出现褥疮复发,皮瓣的质地、颜色和厚度与受术部位周围皮肤的质地、颜色和厚度非常相似,供体和受体区域仅留下线状疤痕。结论使用股后肌皮瓣联合股后皮神经营养血管瓣和闭合灌洗治疗Ⅳ期峡部结节性压疮时,组织瓣可用于充分填充压疮的死腔。治疗后,伤口愈合良好,供区和受区外观更好,压疮不易复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[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].

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.

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