Application of freestyle perforator flap to repair pressure sores in the buttocks
Cao Shikun1, Yu Daojiang2, An Lu1, Lu-Jiang Huiwen1, Cheng Xiaoming3, Sun Wei1, Wu Lijun1, Yu Wenyuan1
1Department of Plastic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004; 2Department of Plastic and Burn Surgery, the Second Affiliated Hospital of Chengdu Medical College, Chengdu 610051; 3Department of Plastic and Burn Surgery, the Liyang People's Hospital, Liyang 213300
Abstract：Objective This study aimed to evaluate the use of freestyle perforator flap in repairing pressure sores in the buttocks.Methods From December 2013 to July 2019, we repaired 39 cases (22 males and 17 females; mean age=71 years) of pressure sores in the buttocks by using a freestyle perforator flap. Among the cases, 19 were in the sacral part, 9 in the femur trochanter, 7 in the ischial tuberosity, and 4 in the sacral part with femur trochanter. Before surgery, the perforator vessels with flow rate of more than 2.5 cm/s around the defect were detected and marked with Doppler. This perforator was used as the blood supply vessel of the free perforator flap. The position of the vascular perforator point was used as the rotation point, and the donor area was optimized in combination with the conventional flap donor area selection principle.After conventional surgical debridement by removing necrotic and inactivated tissues around the ulcer, including scar and fibrotic tissues around the wound, patients with good tissue vitality and no inflammatory reaction on the wound received one-stage flap repair. Conversely, patients with poor tissue vitality and potential tendency for local infection on the wound were subjected to applied vacuum-sealing drainage of the wound for 5-7 days, which were replaced three times, followed by flap repair until good granulation growth on the wound was achieved. During surgery, 34 propeller flaps, 9 rotating flaps, and 7 V-Y propelled flaps were used, among which 30 cases were repaired with single flap and 9 cases with combined flap. The flap resection ranged from 10.5 cm×6.5 cm to 22.0 cm×7.0 cm. All donor areas were sewed and stitched directly. Flap survivability was observed in terms of on time after operation, and treatment was adopted according the symptoms that appeared. Postoperative functional appearance and recurrence were followed-up.Results After operation, the wounds of 37 cases healed in the first stage, and all flaps survived successfully. One case suffered from postoperative bleeding that resulted in necrosis on the distal part; the necrotic tissue was debrided, and the residual flap was dissociated from the surrounding soft tissue and repaired in the secondary stage. One case showed congestion caused by poor venous circulation, and healing was delayed after acupuncture blood-letting treatment. All incisions in the donor area healed in the first stage. All patients were followed-up for 3-24 months (average=6 months) with satisfactory functional and aesthetic outcomes. Two cases recurred because of improper nursing.Conclusions The freestyle perforator flap can reduce the major surgical trauma of the traditional axial flap and musculocutaneous flap and can avoid the difficulties caused by abnormal vascular anatomy during design and operation. This method also has the advantages of reliable blood supply and easy operation. Two cases recurred because of improper nursing the freestyle perforator flap is ideal for repairing pressure sores in the buttocks.
曹世坤, 余道江, 安璐, 陆蒋惠文, 陈晓明, 孙卫, 伍丽君, 于文渊. 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.
Cao Shikun, Yu Daojiang, An Lu, Lu-Jiang Huiwen, Cheng Xiaoming, Sun Wei, Wu Lijun, Yu Wenyuan. Application of freestyle perforator flap to repair pressure sores in the buttocks. Chinese Journal of Anatomy and Clinics, 2020, 25(4): 365-370.
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2020, Vol. 25 
