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Bian K, Qiu C, Lu GJ, Zhao Q, Wang C, Zhang F. Combined application of gluteus maximus muscle flaps and random pattern skin flaps in repairing sacrococcygeal sinus tracts: a prospective study and technical note. Updates Surg 2024; 76:1009-1014. [PMID: 38175503 DOI: 10.1007/s13304-023-01707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Sacrococcygeal sinus ulcers are caused by pressure sores, trauma, or surgery. Several surgical techniques have been developed for its treatment; however, studies are ongoing to develop the ideal method. The present study aims to introduce an innovative application of gluteus maximus muscle flaps (GMMFs) packing combined with local random pattern skin flaps (RPSFs) in repairing sacrococcygeal sinus tracts (SSTs). METHODS This was a prospective analysis study conducted on the patients (n = 26) with SSTs underwent an innovative repairing surgery in Qilu Hospital of Shandong University, China between December 2015 and December 2020. The repairing surgery was GMMFs combined with RPSFs. The demographic information and the clinical parameters including operative time, postoperative healing time, and recurrence rate were used to evaluate the efficacy of the operation. RESULTS Except one case of partial necrosis at the edge of the flap due to severe fibrosis, which was cured after dressing change, all the other cases showed effective healing after the operation. CONCLUSION The combined application of GMMFs and RPSFs for the treatment of sacrococcygeal sinus tracts gains the advantages of short operative time, quick postoperative recovery, and low postoperative recurrence rate.
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Affiliation(s)
- Kai Bian
- Department of Burn and Plastic Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, China
| | - Cheng Qiu
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, China
| | - Guo-Jun Lu
- Department of General Surgery, Peoples Hospital of LaoLing, No. 28, Anju Road, Leling, Dezhou, 253699, China
| | - Qi Zhao
- Department of Burn and Plastic Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, China
| | - Chao Wang
- Department of Burn and Plastic Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, China
| | - Fan Zhang
- Department of Burn and Plastic Surgery, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, China.
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Nicolas G, Ferreira J, Valente D, Abbas L, Saliba M, Milcheski D, Junior AM, Gemperli R. Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol. J Plast Reconstr Aesthet Surg 2024; 92:207-211. [PMID: 38552404 DOI: 10.1016/j.bjps.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV), mainly due to the long-term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair. OBJECTIVES To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID-19. Developing a well-established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID-19 pandemic. METHODS Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID-19 from May 2020 to August 2020 (4 months). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable-adjusted logistic regression was made in order to identify risk factors for complications. RESULTS Thirty-eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0 mg/dl (p = 0,01), leukocyte levels higher than 11.000/mm3 (p = 0,1), and C Reactive protein levels higher than 142 mg/dl (p = 0,06) at the time of reconstruction and bilateral flaps were independent factors for complications. CONCLUSION Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital-acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID-19 pandemic.
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Affiliation(s)
- Gregory Nicolas
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil.
| | - Joao Ferreira
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
| | - Daniel Valente
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
| | - Laielly Abbas
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
| | - Marita Saliba
- Faculty of Medicine, University of Balamand, Lebanon
| | - Dimas Milcheski
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
| | - Araldo Monteiro Junior
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
| | - Rolf Gemperli
- Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil
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Baek SO, Kim SR, Kim HS, Lee JY. Rotational V-Y Fasciocutaneous Advancement Island Flap to Cover Deep Sacrococcygeal Defects due to Pilonidal Disease, Pressure Ulcers, and Other Inflammatory Conditions. Am Surg 2024; 90:770-779. [PMID: 37914195 DOI: 10.1177/00031348231211034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The sacrococcygeal area supports the lower body and endures mechanical forces during movement. However, current treatment methods for deep caudal sacrococcygeal defects have limitations, resulting in insufficient tissue for deep pocket obliteration and considering only the two-dimensional advancement plane in a three-dimensional defect topology. Our study proposes using a rotational V-Y fasciocutaneous advancement island flap to reconstruct deep caudal sacrococcygeal defects. By considering the three-dimensional nature of the defect, we distinguish a coccygeal plane of the V-Y flap from a sacral plane and set different directions and depths of movement for each plane. From March 2016 to July 2022, 12 patients underwent successful treatment with this surgery, and no complications or recurrences were observed in the study group. Our research found that patients in our study exhibited a smaller intercoccygeal angle than the average angle of the general Korean population, as previously reported. This implies a more pronounced curvature between the sacral and coccygeal planes. Therefore, our methods, which consider the three-dimensional structures of sacrococcygeal pathology, are significant. This technique provides a mechanically robust reconstruction after resecting deep sacrococcygeal pathology, with well-padded tissue to prevent dead space and wound disruption.
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Affiliation(s)
- Sang Oon Baek
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Ram Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Sung Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Yong Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Acartürk TO, Seyhan T, Bengür FB, Erbaş VE. A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects: A Method for Practical Harvest and Safe Closure. Ann Plast Surg 2022; 88:313-318. [PMID: 34139742 DOI: 10.1097/sap.0000000000002935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. METHODS Large sacral defects (>100 cm2) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. RESULTS There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm2, between 9 × 8 and 26 × 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm2, between 10 × 10 and 28 × 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. CONCLUSION Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°.
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Affiliation(s)
- Tahsin Oğuz Acartürk
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Tamer Seyhan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Aksaray University School of Medicine, Aksaray, Turkey
| | - Fuat Bariş Bengür
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
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Vathulya M, Praveen AJ, Barik S, Jagtap MP, Kandwal P. A Systematic Review Comparing Outcomes of Local Flap Options for Reconstruction of Pressure Sores. Ann Plast Surg 2022; 88:105-113. [PMID: 34225313 DOI: 10.1097/sap.0000000000002941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pressure sores are agonizing complications of chronically bedridden patients. The management of these lesions particularly with respect to grades III and IV lesions are chiefly surgical and involves a multidisciplinary approach. Although there are a variety of local flap options, like fasciocutaneous flaps, musculocutaneous flaps, perforator flaps, and combinations of these to choose from, there is a paucity of literature regarding which flap is better among these in terms of complication and recurrence rates. METHODS The databases searched were as follows: Cochrane Central Register of Controlled trials (January 2000 to July 2020), MEDLINE (January 2000 to July 2020), and EMBASE (January 2000 to August of 2020). Key words used were "pressure ulcer," "flaps," "surgery," "pressure sore" with limits, "human," and "English." Primary outcomes were "overall complication rates" and "recurrence rates." Overall complication was further categorized as flap necrosis, flap dehiscence, infection, and others. RESULTS Thirty-nine articles were included in the final analysis. There was a statistically significant difference among the various types of flaps for overall complication, flap dehiscence, infection, flap necrosis, and recurrence rates. CONCLUSIONS Our study indicates that musculocutaneous flaps have lower recurrence rates, and combined flaps have lower complication rates. However, various other factors, like donor site morbidity, initial defect size, operating time, intraoperative blood loss, salvage options in case of recurrence, should also be considered while choosing a flap to reconstruct a defect.
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Affiliation(s)
| | - A J Praveen
- From the Department of Burns and Plastic Surgery
| | - Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Pankaj Kandwal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Yan M, Xiaobo Z, Zhaoqi Y, Xiuxia W, Rui J, Fei L, Jun C, Xusong L, Jun Y, Di S. The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study. J Wound Care 2020; 29:562-566. [PMID: 33052792 DOI: 10.12968/jowc.2020.29.10.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to present our experience with a kite flap in reconstruction of facial wounds after malignant tumour excision. METHOD From October 2008 to September 2017, patients with facial malignant tumour were treated in the Xinjiang Uygur Autonomous Region Bazhou People's Hospital with kite flaps after complete excision. The survival rate, colour, cicatrix of the flap and patient satisfaction were recorded after surgery. RESULTS A total of 95 patients were included in the study. During follow-up, from six months to 8 years, all the kite flaps achieved primary closure and survived well, and the colour and texture were similar to the surrounding skin with no obvious scar. Dysfunction, complications and recurrence had not been reported. CONCLUSION The kite flap may be a good option in reconstructing facial wounds after malignant tumour excision (diameters 1-5cm). It is a simple surgical method with sufficient blood supply and extensive adaptability. For patients in this study, no obvious scars were formed and the recipient site matched well with the donor site.
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Affiliation(s)
- Ma Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.,Department of Plastic and Aesthetic Surgery, Xinjiang Uygur Autonomous Region Bazhou People's Hospital, Xinjiang, China
| | - Zhou Xiaobo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Zhaoqi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Wang Xiuxia
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jin Rui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Liu Fei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Chen Jun
- Department of Dermatology and Dermatologic Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao tong University, Shanghai, China
| | - Luo Xusong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Yang Jun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Sun Di
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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Djedovic G, Morandi EM, Metzler J, Wirthmann A, Matiasek J, Bauer T, Rieger UM. The posterior thigh flap for defect coverage of ischial pressure sores - a critical single-centre analysis. Int Wound J 2017; 14:1154-1159. [PMID: 28661069 DOI: 10.1111/iwj.12776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/17/2017] [Indexed: 12/30/2022] Open
Abstract
The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight-bearing area in wheelchair-mobilised patients and is prone to high mobility. The purpose of our study was to report our long-time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap. A retrospective analysis of all primary pressure sores grade III-IV in the ischial area, which were covered with a medially based posterior thigh flap between January 2008 and December 2014, at our department was conducted. A total of 28 patients underwent defect coverage of an ischial pressure sore with the aforementioned flap. The subgroup with complications showed a statistically significant longer hospital stay. A statistically significant correlation between age and the coincidence of comorbidities could be seen. Older patients showed significantly higher grades of pressure sores. The medially based posterior thigh flap is a safe and reliable flap design. Complication rates are comparable to other flaps. Nevertheless, in case of complications, a significantly longer duration of hospitalisation has to be taken into account.
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Affiliation(s)
- Gabriel Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Julia Metzler
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Wirthmann
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt, Germany
| | - Johannes Matiasek
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital Vienna, Vienna, Austria
| | - Thomas Bauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ulrich M Rieger
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt, Germany
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