Phẫu thuật tạo hình loét tỳ đè cung cụt độ III-IV: Lựa chọn vạt tại chỗ và kết quả phẫu thuật trên 26 bệnh nhân

Abstract

This study evaluated the outcomes of reconstructive surgery for stage III–IV sacral pressure ulcers and assess the role of flap selection based on defect characteristics. A non-controlled interventional clinical study was conducted on 26 patients treated at the National Hospital for Tropical Diseases from November 2024 to November 2025. Seventy-three percent of cases were stage IV ulcers, with a mean defect size of 9 × 13 cm. A total of 81% of patients had post-debridement defects with exposed bone and associated dead space; reconstruction in these cases was performed using 14 V–Y musculocutaneous perforator flaps in 12 patients (2 patients required two flaps) and 15 gluteus maximus musculocutaneous rotation flaps in 9 patients (6 patients required two flaps). Five patients had defects without bone exposure or dead space; reconstruction was performed using 2 local fasciocutaneous rotation flaps and 4 fasciocutaneous perforator flaps (1 patient required two flaps). Postoperatively, complete flap survival was achieved in 100% of cases, and primary wound healing was observed in 81% of patients. Five patients developed surgical site infections requiring reoperation. The mean wound healing time was 18 days. No recurrence was observed during the 6-month follow-up period. Reconstruction using local flaps is an effective treatment for stage III–IV sacral pressure ulcers. Flap selection tailored to defect morphology plays a critical role in optimizing surgical outcomes.