Efficacy of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps plus free-style gluteal perforator flaps in the repair of stage Ⅳ sciatic tuberosity pressure ulcers
Objective To explore the clinical efficacy of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps plus free-style gluteal perforator flaps in repairing stage IV sciatic tuberosity pressure ulcers.Methods A retrospective case series study was conducted to analyze the clinical data of 16 patients(16 wounds)with stage Ⅳ sciatic tuberosity pressure ulcers admitted to First Affiliated Hospital of Nanchang University from May 2021 to February 2024,including 10 males and 6 females,aged 21-84 years[(58.5±16.5)years].Among them,8 patients were complicated with chronic osteomyelitis of the ischium at 8 sites.The wound area before debridement ranged from 2.0 cm×1.5 cm to 9.0 cm×7.0 cm.All the patients underwent staged surgery.In phase Ⅰ surgery,the scar tissue at the wound margin,necrotic tissue,bursa,and chronic osteomyelitic lesions were removed in the ischium.After debridement,the wound area ranged from 4.0 cm× 3.0 cm to 12.0 cm×8.0 cm.Negative pressure closure drainage(VSD)was performed and wound bed preparation was completed.In phase Ⅱ surgery,the posterior femoral cutaneous nerve nutrient vessel adipofascial flaps were flipped,filled into the wound cavity,and then used to repair the wound by advancing and rotating in combination with free-style gluteal perforator flap.The area of posterior femoral cutaneous nerve nutrient vessel adipofascial flaps ranged from 9.0 cm×3.5 cm to 19.0 cm×10.0 cm and the area of the free-style gluteal perforator flaps ranged from 5.0 cm×4.0 cm to 13.0 cm×8.5 cm.The amount of bleeding in phase Ⅱ surgery was recorded.The survival and wound healing of the posterior femoral cutaneous nerve nutrient vessel adipofascial flaps and free-style gluteal perforator flaps were observed.At the last follow-up,recurrence of pressure ulcers and osteomyelitis,external appearance of the wound,and secondary functional impairment and deformity in the donor sites were observed.Results All the patients were followed up for 6-15 months[(9.4±3.1)months].The intraoperative bleeding volume in phase Ⅱ surgery was 80-300 ml[(162.9±60.6)ml].All the posterior femoral cutaneous nerve nutrient vessel adipofascial flaps survived well after surgery.A small area of bruising was observed at the distal end of the freestyle gluteal perforator flap in 1 patient at 1 day after surgery,which was relieved after removing some of the sutures.Torn suture of the incision was found as a result of postoperative subcutaneous hematoma in the donor site of the posterior femoral cutaneous nerve nutrient vessel adipofascial flap in 1 patient at 1 day after surgery,which healed at 22 days after bedside debridement and dressing change.All other incisions healed well.At the last follow-up,there was no recurrence of pressure ulcers or osteomyelitis and the wound was mildly pigmented and soft.There were no secondary functional impairments or deformities in the posterior femoral or gluteal donor sites.Conclusion Posterior femoral cutaneous nerve nutrient vessel adipofascial flaps plus freestyle gluteal perforator flaps can be used in the repair of stage Ⅳ sciatic tuberosity pressure ulcer wounds,with the advantages of less intraoperative bleeding,high tissue flap survival rate,good wound healing,no recurrence of pressure ulcers or osteomyelitis after surgery,good wound appearance and texture,and no secondary functional impairment or deformity in the donor sites.
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