Objective: To explore the clinical effect of X-N advancement flap in repairing pressure ulcer on the buttock or back. Methods: From June 2018 to June 2019, 20 patients with grade Ⅳ pressure ulcers on the buttock or back were hospitalized and treated in the Department of Traumatology, Burns and Plastic Surgery of Fourth Affiliated Hospital of Guangxi Medical University, including 15 males and 5 females, aged 48-89 years. The area of the patient's wound was 8 cm×5 cm-15 cm×12 cm after debridement, and all were repaired with the X-N advancement flap designed by the author. The flap was designed according to the direction of skin relaxation on both sides of the wound, and the skin was incised in X-shape and sutured in N-shape. The width and advancement distance of the flap were recorded, and the ratio of the advancement distance to the width of the flap was calculated. The flap survival, complication, and follow-up were observed and recorded. Results: The width of the flap was (5.9±1.2) cm, the advancement distance of the flap was (10.3±2.5) cm, and the ratio of the advancement distance to the width of the flap was 1.8±0.4. All the flaps survived, and none of the flaps had blood flow disorder. Local dehiscence occurred in the flap of one patient 1 week after surgery, which was healed after laying on the floating bed, strengthened care, and wound dressing change. The flap of one patient developed infection 5 days after surgery, which was healed after partial suture removal, smooth drainage, and replacement with sensitive antibiotics. The wounds of the remaining 18 patients were all cured. After 3 months of follow-up, the flaps survived well with good elasticity and texture. Conclusions: The X-N advancement flap can make the skin and soft tissue move forward effectively. It is simple and effective to repair pressure ulcers on the back or buttock of patients with this flap, which is worthy of clinical promotion and application.
目的： 探讨X-N推进皮瓣在臀部或背部压疮创面修复中的临床效果。 方法： 2018年6月—2019年6月，广西医科大学第四附属医院创伤修复烧伤整形科收治20例臀部或背部Ⅳ级压疮患者，其中男15例、女5例，年龄48～89岁。患者创面清创后面积为8 cm×5 cm～15 cm×12 cm，采用笔者自行设计的X-N推进皮瓣进行修复。根据创面两侧皮肤松弛方向设计皮瓣，将皮肤X形切开后N形缝合。统计皮瓣宽度、推进距离，计算推进距离与皮瓣宽度比值，观察并记录皮瓣成活情况、并发症发生情况及随访情况。 结果： 皮瓣宽度为(5.9±1.2)cm，皮瓣推进距离为(10.3±2.5)cm，皮瓣推进距离与皮瓣宽度比值为1.8±0.4。20例患者皮瓣全部成活，无一例皮瓣出现血运障碍。1例患者皮瓣于术后1周出现局部裂开，予上悬浮床、加强护理、创面换药后愈合；1例患者皮瓣术后5 d出现感染，予局部拆线引流，更换敏感抗生素后愈合；其余18例患者创面全部治愈。随访3个月，皮瓣存活良好，弹性、质地均较佳。 结论： X-N推进皮瓣可有效推进皮肤软组织，用其修复患者背部或臀部压疮操作简单、效果好，值得临床推广应用。.
Keywords: Pressure ulcers; Wound healing; X-N advancement flap.