[摘要]目的：探讨采用en bloc切除清创联合阔筋膜张肌穿支接力皮瓣一期修复大转子压疮的临床效果。方法：选取2019年12月-2023年12月笔者科室治疗的13例大转子Ⅲ、Ⅳ期压疮患者，共18处压疮，压疮面积为3.0 cm×2.0 cm～9.0 cm×6.0 cm，采用en bloc切除清创将压疮病灶组织彻底清除，清创后创面面积为4.0 cm×3.0 cm～11.0 cm×9.0 cm，一期设计阔筋膜张肌穿支接力皮瓣修复大转子压疮，主瓣修复压疮，副瓣覆盖主瓣供区，副瓣供区直接拉拢缝合，其中主瓣面积5.0 cm×4.0 cm～13.0 cm×10.0 cm、副瓣面积3.0 cm×2.0 cm～7.0 cm×4.0 cm。术后观察皮瓣存活及并发症情况，随访皮瓣的外观、质地以及压疮有无复发。结果：1例患者1处皮瓣副瓣远端小面积坏死，经床旁清创缝合后创面愈合，其余皮瓣均存活良好，术后未出现出血、感染、脂肪液化及切口开裂等不良并发症；所有患者随访3～18个月，皮瓣色泽及外观较好，外形满意，均未见压疮复发。结论：采用en bloc切除清创联合阔筋膜张肌穿支接力皮瓣修复大转子压疮，可一期修复压疮，且供瓣区处无张力缝合外层皮肤，操作简单，外观良好，临床效果较佳。

[关键词]压力性溃疡；大转子；皮瓣；en bloc切除；清创；压疮

[中图分类号]R622" " [文献标志码]A" " [文章编号]1008-6455（2025）06-0035-04

En bloc Resection and Debridement Combined with Tensor Fascia Lata Perforator Relay Flap for One-stage Repair of Greater Trochanteric Pressure Ulcers

DENG Rufei， FAN Baowen， CHEN Yanwei， ZHANG Yonghong， ZHANG Youlai， JIANG Zhenyu，

ZOU Lijin， WANG Lihui

（ Medical Center of Burn Plastic and Wound Repair， the First Affiliated Hospital of Nanchang University， Nanchang 330006， Jiangxi， China ）

Abstract： Objective" Exploring the clinical effect of using en bloc excision and debridement combined with tensor fascia lata perforator relay skin flap for one-stage repair of greater trochanteric pressure ulcers. Methods" Thirteen patients with stage Ⅲ and Ⅳ pressure ulcers of the greater trochanter were selected from the author's department from December 2019 to December 2023， with a total of 18 pressure ulcers， with an area of 3.0 cm × 2.0cm-9.0 cm × 6.0 cm. The en bloc excision and debridement were used to completely remove the lesion tissue of pressure ulcers. After debridement， the wound area was 4.0 cm × 3.0 cm-11.0 cm × 9.0 cm. In the first phase， the tensor fasciae lata muscle perforator relay flap was designed to repair the greater trochanter pressure ulcers， with the main valve repairing the pressure ulcers and the auxiliary valve covering the main valve supply area. The auxiliary valve supply area was directly pulled and sutured， with the main valve area of 5.0 cm × 4.0 cm-13.0 cm × 10.0 cm and the auxiliary valve area of 3.0 cm × 2.0 cm-7.0 cm × 4.0 cm. Postoperative observation of skin flap survival and complications， follow-up of skin flap appearance， texture， and recurrence of pressure ulcers. Results" One patient had a small area of necrosis at the distal end of one side flap. After bedside debridement and suturing， the wound healed. All other flaps survived well， and there were no adverse complications such as bleeding， infection， fat liquefaction， or incision cracking after surgery; All patients were followed up for 3-18 months， and the skin flap had good color and appearance， satisfactory appearance， and no recurrence of pressure ulcers was observed. Conclusion" The use of en bloc debridement combined with tensor fascia lata perforator relay skin flap for repairing greater trochanteric pressure ulcers can achieve one-stage repair of pressure ulcers without tension suturing the outer skin at the donor site. The operation is simple， the appearance is good， and the clinical effect is good.

Key words： pressure ulcer; greater trochanter; flaps; en bloc resection; debridement; pressure sore

压疮是指由压力或压力联合剪切力所致的皮肤和/或皮下组织的局部损伤、缺血坏死及溃烂[1]，股骨大转子系体表骨突部位，具有皮下组织少、易受压等特点，是压疮的好发部位，也是临床中较难处理的压疮之一[2]。治疗和护理压疮需要消耗大量人力物力，清创换药或外科植皮治疗大转子压疮效果欠佳[3]。目前外科皮瓣仍是大转子Ⅲ、Ⅳ期压疮的最佳治疗手段，但移植皮瓣治疗前的关键环节在于对压疮行彻底清创。……